ADMINISTRATION ROUTES:
IV, IM, SC, Endotracheal
ALTERNATIVE NAMES:
Atropine
ICU INDICATIONS:
-
To temporarily increase heart rate or decrease AV-block until definitive intervention can take place
-
As an antidote for inadvertent overdose of cholinergic drugs or for cholinesterase poisoning such as from organophosphorus insecticides
PRESENTATION AND ADMINISTRATION:
Atropine vials contain 600 mcg in 1 mL or 1200 mcg in 1 mL
Atropine mini-jets contain 1mg in 10 mL (i.e. 100 mcg/mL)
Compatible with the following IV fluids:
Dilution in IV fluids is not recommended
Atropine sulphate is stated to be compatible, when mixed in a syringe immediately before use, with the following:
Chlorpromazine, droperidol, fentanyl, glycopyrrolate, metoclopramide, midazolam, morphine, pethidine, prochlorperazine, promethazine, ranitidine
If the solution is cloudy, do not use
Store at room temperature below 25°C
DOSAGE:
IV:
Bradycardia:
0.6 mg IV
Organophosphate poisoning:
2 mg IV then 2 mg every 15 minutes until atropinised, then 0.02-0.08 mg/kg/hr for several days
Endotracheal route (only if IV access cannot be obtained)
1 to 2 mg diluted to total <10 mL of sterile water or Normal saline
Note: The administration of less than 0.5mg can produce a paradoxical bradycardia because of the central or peripheral parasympathomimatic effects of low doses in adults
DOSAGE IN RENAL FAILURE AND RENAL REPLACEMENT THERAPY:
Dose as in normal renal function
DOSAGE IN PAEDIATRICS:
IV:
Bradycardia:
0.02 mg/kg
CLINICAL PHARMACOLOGY:
Atropine is commonly classified as an anticholinergic or antiparasympathetic (parasympatholytic) drug. More precisely however it is termed an antimuscarinic agent since it antagonizes the muscarine-like actions of acetylcholine and other choline esters.
CONTRAINDICATIONS:
There are no absolute contraindications to atropine. However, atropine is relatively contraindicated in:
-
Pyloric stenosis
-
Glaucoma
-
Prostatic hypertrophy
WARNINGS:
In adults, the administration of less than 0.5 mg can produce a paradoxical bradycardia because of central or peripheral parasympathomimatic effects at low dose. Conventional systemic doses may precipitate acute glaucoma in susceptible patients, convert partial organic pyloric stenosis into complete obstruction, lead to complete urinary retention in patients with prostatic hypertrophy or cause inspissation of bronchial secretions and formation of dangerous viscid plugs in patients with chronic lung disease
PRECAUTIONS:
General:
See WARNINGS above
Laboratory Tests:
No Laboratory Tests: in addition to routine tests are required.
Drug/Laboratory Test Interactions:
None known
IMPORTANT DRUG INTERACTIONS IN ICU:
None of note.
ADVERSE REACTIONS:
Body as a Whole:
Thirst
Cardiovascular System:
Tachycardia
Gastrointestinal System:
Dry mouth, constipation
Neurological System:
Blurred vision, dilated pupils, difficulty in swallowing, tremor
Urological System:
Difficulty in micturition