Atropine

Atropine IV/IM is a prescription medication used to treat the symptoms of Anesthesia Premedication, Sinus Bradycardia (ACLS), Bronchospasm, Organophosphate or Carbamate (Cholinesterase Inhibitors) Poisoning.

• Atropine IV/IM is available under the following different brand names: AtroPen

Adult and Pediatric dosage

Intramuscular device

• 0.25mg/0.3mL
• 0.5mg/0.7mL
• 1mg/0.7mL
• 2mg/0.7mL

Injectable solution

• 0.05 mg/mL
• 0.1mg/mL
• 0.4mg/mL
• 0.8mg/mL
• 1mg/mL

Anesthesia Premedication

Adult dosage: 

• 0.4-0.6 mg IV/IM/SC 30-60 minutes before anesthesia; repeat every 4-6 hours as needed

Pediatric dosage

• Children weighing less than 5 kg: 0.02 mg/kg/dose 30-60 minutes preop; then every 4-6 hours as needed
• Children weighing more than 5 kg: 0.01-0.02 mg/kg IV/IM/SC; no more than 0.4 mg

Sinus Bradycardia (ACLS)

Adult dosage

• 0.5-1 mg or 0.04 mg/kg IV every 5 minutes, no more than 3 mg

Pediatric dosage

• 0.02 mg/kg IV/IO every 5 minutes for 2-3 doses as needed; single dose no less than: 0.1 no more than 0.5 mg (children), 1 mg (adolescents)
• No more than 1 mg (children), 2 mg (adolescents)

Bronchospasm

Adult dosage

• 0.025 mg/kg in 2.5 mL NS every 6-8 hours via nebulizer; no more than 2.5 mg/dose

Pediatric dosage

• 0.025-0.05 mg/kg in 2.5 mL NS every 6-8 hours via nebulizer; no more than 2.5 mg/dose

Organophosphate or Carbamate (Cholinesterase Inhibitors) Poisoning

Adult dosage

• Administer 1 injection (2 mg) IM; if after the first dose, patient develops severe symptoms, administer 2 additional injections IM in rapid succession

Pediatric dosage

• IV 0.03-0.05 mg/kg IV/IM/IO/ET every 10-20 minutes as needed to effect; then every 1-4 hours for at least 24 hours
• IM Autoinjector: Administer one injection (2 mg) IM, if after the first dose, patient develops severe symptoms, administer 2 additional injections IM in rapid succession

Severe symptoms:

• 3 AtroPen doses in rapid succession
• Children weighing less than 41 kg: 2 mg/dose IM
• Children weighing 18-41 kg: 1 mg/dose IM
• Children weighing 6.8-18 kg: 0.5 mg/dose IM
• Children weighing less than 6.8 kg: AtroPen formulation not recommended; administer atropine 0.05 mg/kg bradyarrhythmias

Dosage Considerations – Should be Given as Follows: 

• See "Dosages."

Common side effects of Atropine IV/IM include:

• fast heartbeats, 
• pounding heartbeats, 
• fluttering in your chest, 
• flushing (sudden warmth, redness, or tingly feeling), 
• urinary problems, 
• constipation, 
• bloating, 
• stomach pain, 
• nausea, 
• vomiting, 
• loss of interest in sex, 
• impotence, 
• dry mouth, 
• dry eyes, 
• blurred vision, 
• increased sensitivity to light, 
• confusion, 
• dizziness, 
• headache, and 
• drowsiness 

Serious side effects of Atropine IV/IM include:

• hives, 
• difficulty breathing, 
• swelling of the face, lips, tongue, or throat, 
• lightheadedness, 
• pounding heartbeats, 
• fluttering in the chest, 
• nausea, 
• vomiting, 
• stomach pain, 
• feeling full after eating a small amount, 
• blurred vision, 
• tunnel vision, 
• eye pain, 
• seeing halos around lights, 
• trouble swallowing, 
• restlessness, 
• excitement, 
• tremors, 
• problems with balance or muscle movement, 
• increased thirst, 
• hot and dry skin, 
• tiredness, and
• severe skin rash

Rare side effects of Atropine IV/IM include:

• none 

This is not a complete list of side effects and other serious side effects or health problems may occur as a result of the use of this drug. Call your doctor for medical advice about serious side effects or adverse reactions. You may report side effects or health problems to FDA at 1-800-FDA-1088.

If your medical doctor is using this medicine to treat your pain, your doctor or pharmacist may already be aware of any possible drug interactions and may be monitoring you for them.  Do not start, stop, or change the dosage of any medicine before checking with your doctor, health care provider or pharmacist first

• Atropine IV/IM has severe interactions with no other drugs.
• Atropine IV/IM has serious interactions with the following drugs: 
  • glycopyrronium tosylate topical
  • pramlintide
  • umeclidinium bromide/vilanterol inhaled
• Atropine IV/IM has moderate interactions with at least 92 other drugs.
• Atropine IV/IM has minor interactions with at least 26 other drugs. 

This information does not contain all possible interactions or adverse effects. Visit the RxList Drug Interaction Checker for any drugs interactions. Therefore, before using this product, tell your doctor or pharmacist of all the products you use.  Keep a list of all your medications with you, and share this information with your doctor and pharmacist.  Check with your health care professional or doctor for additional medical advice, or if you have health questions, concerns.

Contraindications

• No absolute contraindications for ACLS
• Ineffective in hypothermic bradycardia
• Narrow-angle glaucoma, tachycardia, asthma, GI obstruction, severe ulcerative colitis, toxic megacolon, bladder outlet obstruction 

Effects of drug abuse

• None

Short-Term Effects

• See “What are Side Effects Associated with Using Atropine IV/IM?”

Long-Term Effects

• See “What Are Side Effects Associated with Using Atropine IV/IM?”

Cautions

• Caution in hepatic/renal impairment, BPH, CHF
• Not for effective treatment of type II second or third-degree AV block with or without a new wide QRS complex
• Use caution in autonomic neuropathy, myocardial ischemia, heart failure, paralytic ileus, hepatic impairment, hiatal hernia associated with reflux esophagitis, hyperthyroidism, myasthenia gravis, and renal impairment
• May inhibit sweating which, in a warm environment or with excessive exercise, can lead to hyperthermia and heat injury; to the extent feasible, avoid excessive exercise and heat exposure
• Psychosis reported in sensitive individuals and with excessive doses
• When recurrent use of atropine is essential in patients with coronary artery disease, total dose should be restricted to 2 to 3 mg (maximum 0.03 to 0.04 mg/kg) to avoid detrimental effects of atropine-induced tachycardia on myocardial oxygen demand
• May cause acute glaucoma; administer with caution in patients at risk for acute glaucoma or who have severe narrow angle glaucoma; monitor for signs and symptoms of intraocular pressure, as appropriate
• May convert partial organic pyloric stenosis into complete obstruction; patients should be monitored for gastrointestinal symptoms following administration
• May cause urinary retention; administer with caution to patients with clinically significant bladder outflow obstruction
• May cause thickening of bronchial secretions and formation of dangerous viscid plugs in individuals with chronic lung disease; respiratory status should be monitored in individuals with chronic lung disease following administration of therapy
• Drug can cause hypersensitivity reactions, including anaphylactic reactions; medical supervision necessary in patients who have had previous anaphylactic reactions to drug and require treatment for organophosphorus or nerve agent poisoning
• Cardiovascular risks
  • Cardiovascular adverse reactions reported include, but are not limited to, sinus tachycardia, palpitations, premature ventricular contractions, atrial flutter, atrial fibrillation, ventricular flutter, ventricular fibrillation, cardiac syncope, asystole, and myocardial infarction
  • In patients with a recent myocardial infarction and/or severe coronary artery disease, there is possibility that atropine-induced tachycardia may cause ischemia, extend or initiate myocardial infarcts, and stimulate ventricular ectopy and fibrillation
  • Use with caution in patients with known cardiovascular disease or cardiac conduction problems

Pregnancy and Lactation

• Drug readily crosses the placental barrier and enters fetal circulation; there are no adequate data on developmental risk associated with use of atropine in pregnant women; adequate animal reproduction studies have not been conducted with atropine. 
• Drug reported to be excreted in human milk; there are no data on effects of atropine on breastfed infant or effects on milk production; developmental and health benefits of breastfeeding should be considered along with mother’s clinical need for therapy and any potential adverse effects on breastfed infant from therapy or from underlying maternal condition