Atropine Sulfate

Anticholinergic agent

• Parasympatholytic: inhibits action of acetylcholine at postganglionic parasympathetic neuroeffector sites.
• Increases heart rate in life-threatening bradyarrhythmias.

Hemodynamically unstable bradycardia, asystole, bradycardic (<60 beats/min) pulseless electrical activity (PEA), organophosphate poisoning, bronchospastic pulmonary disorders.

Tachycardia, hypersensitivity, unstable cardiovascular status in acute hemorrhage and myocardial ischemia, narrow-angle glaucoma.

Headache, dizziness, palpitations, nausea and vomitting, tachycardia, arrhythmias, anticholinergic effects (blurred vision, dry mouth, urinary retention), paradoxical bradycardia when pushed slowly or at low doses, flushed, hot dry skin.

Potential adverse effects when administered with digoxin, cholinergics, physostigmine. Effects enhanced by antihistamines, procainamide, quinidine, antipsychotics, benzodiazepines, and antidepressants.

• Prefilled syringes: 1mg in 10mL (0.1mg/mL).
• Nebulizer: 0.2% (1mg in 0.5mL) and 0.5% (2.5mg in 0.5mL).

• Adult: Asystole or Bradycardic PEA: 1mg IV/IO push. may repeat every 3-5 min. (if asystole or PEA persists) to a maximum of 3 doses (3mg). Endotracheal administration: 2-3 mg diluted in 10 mL of water ot NS. Unstable bradycardia: 0.5mg IV/IO every 3-5 min. as needed, not to exceed total dose of 3mg. Use shorter dosing interval (3 min.) and higher doses in severe clinical conditions. Organophosphate poisoning: Extremely large doses (2-4mg of higher) may be needed.
• Pediatric: 0.02 mg/kg via IV/IO push; may double this dose for second IV/IO dose. Minimum single dose: 0.1mg. Maximum doses: child single dose: 0.5mg, child total dose: 1mg, adolesent single dose: 1mg, adolesent total dose: 2mg. endotracheal administration: 0.03mg/kg (absorption may be unreliable).

• Onset: immediate.
• Peak effect: rapid to 1-2 min.
• duration: 2-6 hrs.

Pregnancy safety: category C. Moderate doses may cause pupillary dilation.