Atropine sulfate parenteral
- Drugs List
- Therapeutic Indications
- Dosage
- Administration
- Contraindications
- Precautions and Warnings
- Pregnancy and Lactation
- Side Effects
- Monograph
Presentation
Injections of atropine sulfate.
Drugs List
Therapeutic Indications
Uses
Bradycardia after myocardial infarction
Bradycardia occurring during cardiopulmonary resuscitation
Intraoperative bradycardia: treatment
Muscarinic side-effects of neostigmine: control of
Overdosage with parasympathetic agents
Poisoning due to mushroom ingestion
Poisoning due to organophosphate pesticides
Premedication - anticholinergic
Unlicensed Uses
Muscarinic side-effects of edrophonium: control of
Overdosage with beta-adrenoceptor blocking drugs
Dosage
Dosage recommendations vary between different brands/manufacturers.
Adults
Premedication before anaesthesia
300micrograms to 600micrograms by intravenous injection immediately before induction of anaesthesia or by intramuscular or subcutaneous injection 30 to 60 minutes before induction.
Bradyarrhythmias
300micrograms to 1mg by intravenous injection. May be repeated every 4 to 6 hours. Maximum dose is 2mg.
Cardiopulmonary resuscitation
Sinus bradycardia:500micrograms by intravenous injection repeated at 2 to 5 minute intervals until the desired heart rate is achieved.
AV block: 500micrograms by intravenous injection, every 3 to 5 minutes (maximum 3mg).
To control muscarinic side effects of neostigmine
600micrograms to 1.2mg by intravenous injection.
Overdosage or poisoning due to anticholinesterase compounds
1mg to 2mg by intravenous or intramuscular injection every 5 to 60 minutes until signs of atropinisation appear. Maximum of 100mg in the first 24 hours.
Antidote to organophosphates, cholinesterase inhibitors and in muscarinic mushroom poisoning
500micrograms to 2mg can be repeated after 5 minutes and subsequently every 10 to 15 minutes as required, until signs and symptoms disappear (this dose may be exceeded many times).
Treatment of cholinergic crisis of myasthenia gravis
400micrograms to 2mg intravenously, which may be titrated according to patients response.
To control muscarinic side effects of edrophonium (unlicensed)
600micrograms by intravenous injection.
Overdosage with beta-adrenoceptor blocking drugs (unlicensed)
500micrograms to 1.2mg by intravenous injection, repeat doses may be necessary.
Children
Premedication before anaesthesia
Intramuscular or subcutaneous injection 30 to 60 minutes before induction
Children with bodyweight over 20kg: (See Dosage; Adult).
Children with bodyweight 12kg to 16kg: Up to 300micrograms.
Children with bodyweight 7kg to 9kg: Up to 200micrograms.
Children with bodyweight up to 3kg: Up to 100micrograms (up to 60micrograms in premature infants).
The following alternative dosing schedule may be suitable:
Children aged 12 to 18 years: 300micrograms to 600micrograms by intravenous injection immediately before induction of anaesthesia or by intramuscular or subcutaneous injection 30 to 60 minutes before induction.
Children aged 1 month to 12 years: 10micrograms/kg to 30micrograms/kg to be administered 30 to 60 minutes before induction of anaesthesia (minimum of 100micrograms, maximum of 600micrograms).
Intravenous injection immediately before induction
Children aged 12 to 18 years: 300micrograms to 600micrograms.
Children aged 1 month to 12 years: 10micrograms/kg to 20microgram/kg (maximum of 600micrograms).
Intraoperative bradycardia (unlicensed)
Children aged 12 to 18 years: 300micrograms to 600micrograms by intravenous injection (larger doses in emergencies).
Children aged 1 month to 12 years: 10micrograms/kg to 20micrograms/kg.
Cardiopulmonary resuscitation
Children aged 12 to 18 years: 500micrograms by intravenous injection repeated at 2 to 5 minute intervals until the desired heart rate is achieved.
Children under 12 years: 20microgram/kg intravenously as a single dose.
To control muscarinic side effects of neostigmine
Children aged 12 to 18 years: 600micrograms to 1.2mg by intravenous injection.
Children aged 1 month to 12 years: 20microgram/kg (maximum 1.2mg) by intravenous injection.
Antidote to organophosphates, cholinesterase inhibitors and in muscarinic mushroom poisoning
Children aged 12 to 18 years: 1mg to 2mg by intravenous or intramuscular injection every 5 to 60 minutes until signs of atropinisation appear. Maximum of 100mg in the first 24 hours.
Children aged under 12 years: 20micrograms/kg to 50microgram/kg by intravenous or intramuscular injection every 5 to 30 minutes until signs of atropinisation appear. Dosage recommendations vary between different brands/manufacturers, consult product literature.
Overdosage with beta-adrenoceptor blocking drugs (unlicensed)
20microgram/kg (maximum of 1.2mg) by intravenous injection, repeat doses may be necessary.
Neonates
Premedication before anaesthesia
Intramuscular or subcutaneous injection 30 to 60 minutes before induction.
Neonate with bodyweight 7kg to 9kg: Up to 200micrograms.
Neonate with bodyweight up to 3kg: Up to 100micrograms (up to 60 micrograms in premature infants).
OR
Full-term infants: 100micrograms.
Premature infants: 65micrograms.
The following alternative dosing schedule may be suitable:
10microgram/kg.
Intravenous injection immediately before induction of anaesthesia (unlicensed)
300micrograms to 600micrograms.
Intraoperative bradycardia (unlicensed)
10micrograms/kg to 20micrograms/kg by intravenous injection.
Cardiopulmonary resuscitation
20microgram/kg intravenously as a single dose.
To control muscarinic side effects of neostigmine
20micrograms/kg by intravenous injection.
Overdosage or poisoning due to anticholinesterase compounds
50microgram/kg by intravenous or intramuscular injection every 5 to 30 minutes until signs of atropinisation appear.
Administration
For intramuscular, intravenous or subcutaneous administration.
Contraindications
Achalasia
Benign prostatic hyperplasia
Breastfeeding
Gastrointestinal obstruction
Narrow angle glaucoma
Paralytic ileus
Pyloric obstruction
Severe ulcerative colitis
Toxic megacolon
Precautions and Warnings
Children under 18 years
Diarrhoea
Down's syndrome
Elderly
Febrile disorder
Infants weighing less than 3kg
Pyrexia
Autonomic neuropathy
Cardiac arrhythmias
Cardiac failure
Cardiac impairment
Cardiac surgery
Chronic respiratory impairment
Gastrointestinal atony
Heart transplant
Hepatic impairment
Hiatus hernia
Hypertension
Hyperthyroidism
Ischaemic heart disease
Myasthenia gravis
Myocardial infarction
Peptic ulcer
Pregnancy
Reflux oesophagitis
Renal impairment
Tachycardia
Thyrotoxicosis
Ulcerative colitis
Urinary retention
Advise ability to drive/operate machinery may be affected by side effects
Not all available brands are licensed for all indications
The use of atropine for therapeutic or diagnostic procedures in heart transplant patients should be undertaken with extreme caution, and ECG monitoring and equipment for immediate temporary pacing should be available.
Antimuscarinics such as atropine may delay gastric emptying, decrease gastric motility and relax the oesophageal sphincter. Should be used with caution in patients whose conditions may be aggravated by these effects e.g. reflux oesophagitis.
Atropine should be used only with extreme caution in toxic pyrexial children, or in high ambient temperatures because of the danger of hyperpyrexia.
Pregnancy and Lactation
Pregnancy
Use atropine with caution during pregnancy.
The manufacturer recommends that atropine should not be used during pregnancy unless clearly necessary. Studies have found that atropine rapidly crosses the placental barrier. Intravenous administration of atropine during pregnancy or at term may cause tachycardia in the foetus and the mother.
Lactation
Atropine is contraindicated during breastfeeding.
The manufacturer advises that the patient either discontinues atropine or discontinues breastfeeding. Small amounts of atropine are excreted in human breast milk and may cause antimuscarinic effects in the infant. Atropine may also inhibit lactation, particularly upon repeated use. If it is decided to continue breastfeeding during treatment, the child should be monitored for anticholinergic effects.
Side Effects
Allergic reaction
Anaphylaxis
Angina
Anhidrosis
Arrhythmias
Ataxia
Bloating
Blurred vision
Bradycardia then tachycardia
Confusion
Constipation
Decreased bronchial secretions
Delirium
Difficulty in swallowing
Dilatation of pupils
Disturbances in accommodation
Dizziness
Drowsiness
Dry mouth
Dry skin
Excitement
Fever
Flushing
Gastric secretions decreased
Gastroesophageal reflux
Giddiness
Hallucinations
Headache
Hypertensive crisis
Hyperthermia
Increased intra-ocular pressure
Insomnia
Nausea
Nervousness
Palpitations
Photophobia
Psychotic reactions
Rash
Restlessness
Seizures
Tachycardia
Taste loss (reversible)
Thirst
Urinary retention
Urinary urgency
Urticaria
Ventricular fibrillation
Vomiting
Weakness
Overdosage
It is strongly recommended that the UK National Poisons Information Service be consulted on cases of suspected or actual overdose where there is doubt over the degree of risk or about appropriate management.
The following number will direct the caller to the relevant local centre (0844) 892 0111
Information may be obtained if you have access to ToxBase the primary clinical toxicology database of the National Poisons Information Service. This is available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).
Further Information
Last Full Review Date: July 2014
Reference Sources
Drugs During Pregnancy and Lactation: Treatment Options and Risk Assessment, 2nd edition (2007) ed. Schaefer, C., Peters, P. and Miller, R. Elsevier, London.
Drugs in Pregnancy and Lactation: A Reference Guide to Fetal and Neonatal Risk, 9th edition (2011) ed. Briggs, G., Freeman, R. and Yaffe, S. Lippincott Williams & Wilkins, Philadelphia.
Martindale: The Complete Drug Reference, 37th edition (2011) ed. Sweetman, S. Pharmaceutical Press, London.
Summary of Product Characteristics: Atropine Injection BP Minijet. International Medication Systems (UK) Ltd. Revised January 2011.
Summary of Product Characteristics: Atropine sulfate 500microgram/5ml solution for injection in pre-filled syringe. Aguettant Ltd. Revised January 2019.
Summary of Product Characteristics: Atropine sulfate 1mg/5ml solution for injection in pre-filled syringe. Aguettant Ltd. Revised November 2012.
Summary of Product Characteristics: Atropine sulfate 3mg/10ml solution for injection in pre-filled syringe. Aguettant Ltd. Revised March 2013.
Summary of Product Characteristics: Atropine sulfate injection 600 mcg in 1ml (hameln). Hameln Pharmaceuticals Ltd. Revised April 2008.
Summary of Product Characteristics: Atropine sulfate injection BP 600 micrograms/1ml. Amdipharm Mercury Company Ltd. Revised August 2012.
NICE - Evidence Services
Available at: www.nice.org.uk
Last accessed: 23 May 2022
Medscape UK | Univadis prescription drug monographs & interactions are based on FDB Multilex Content
FDB Disclaimer : FDB Multilex is intended for the use of healthcare professionals and is provided on the basis that the healthcare professionals will retain FULL and SOLE responsibility for deciding what treatment to prescribe or dispense for any particular patient or circumstance.