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Clinical Practice Guidelines
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Atropine

Classification

Anticholinergic

Antimuscarinic

Indications

ACP: Restoration of heart rate in bradydysrhythmia

ACP: Sinus bradycardia (rate < 50/minute) with hemodynamic compromise

ACP: Bradycardia secondary to atrioventricular nodal blocks

ACP: Treatment of organophosphate poisoning

ACP: Control of secretions in palliative care (requires additional endorsement)

Contraindications

Hypersensitive to atropine or other anticholinergics
Tachycardia
Narrow-angle glaucoma
Thyrotoxicosis
Prostatic hypertrophy
Myasthenia gravis

Adult dosages

Atropine must be given in the correct dose, and must be given quickly: underdosing, or slow administration, may cause paradoxical slowing of the heart rate.

ACP: Bradycardia

0.6 mg IV push to maximum dose of 0.04 mg/kg (~3 mg in most patients)

ACP: Organophosphate toxicity

Mandatory: Contact CliniCall to discuss treatment plan
1-2 mg IM/IV, repeated every 5-60 minutes until symptoms resolve

ACP: Secretion control in palliative care

0.6 mg IM

Pediatric Considerations And Dosing

Atropine must be given in the correct dose, and must be given quickly: underdosing, or slow administration, may cause paradoxical slowing of the heart rate.

Follow weight-based dosing.

ACP: Bradycardia

0.02 mg/kg IV push. Minimum dose is 0.1 mg. Maximum dose of 0.04 mg/kg.

ACP: Organophosphate toxicity

Mandatory: Contact CliniCall to discuss treatment plan.
0.02-0.05 mg IV every 10-20 minutes until atropine effects are seen

Mechanism Of Action

Atropine competitively antagonizes acetylcholine at muscarinic receptors, producing parasympatholytic and vagolytic effects.

Pharmocokinetics

Following intravenous administration:

Onset: 2-4 minutes
Peak: 2-4 minutes
Half-life: 13-40 hours
Duration: 4-6 hours

Adverse Effects

Common adverse effects include tachycardia, dry mouth, headaches, blurred vision, and dysphagia.

Overdose

Signs and symptoms of overdose are similar to adverse effects.

Warning And Precautions

Atropine produces pupillary dilation. Assessment of pupils may be unreliable.