|•||IM: Given preoperatively to decrease oral and respiratory secretions.|
|•||IV: Treatment of sinus bradycardia and heart block.|
|•||PO: Adjunctive therapy in the management of peptic ulcer and irritable bowel syndrome.|
|•||IV: Reversal of adverse muscarinic effects of anticholinesterase agents (neostigmine, physostigmine, or pyridostigmine).|
|•||IM, IV: Treatment of anticholinesterase (organophosphate pesticide) poisoning.|
|•||Inhaln: Treatment of exercise-induced bronchospasm.|
Adults: 0.4 to 0.6 mg every 4 to 6 h.
Children: PO Use lowest effective dose. The following doses may be exceeded in certain cases: 7 to 16 lb: 0.1 mg; 17 to 24 lb: 0.15 mg; 24 to 40 lb: 0.2 mg; 40 to 65 lb: 0.3 mg; 65 to 90 lb: 0.4 mg; over 90 lb: 0.4 mg.
Adults: Subcutaneous/IM/IV 0.4 to 0.6 mg every 4 to 6 h.
Children: Subcutaneous/IM/IV 0.01 mg/kg to max of 0.4 mg every 4 to 6 h.
Infants less than 5 kg: Subcutaneous/IM/IV 0.04 mg/kg.
Infants over 5 kg: Subcutaneous/IM/IV 0.03 mg/kg.
Adults: Subcutaneous/IM/IV 0.4 to 2 mg every 1 to 2 h as needed.
Children: Subcutaneous/IV/IM 0.01 to 0.03 mg/kg, every 1 to 2 h as needed.
Antidote (Insecticide Poisoning)
Adults: Parenteral At least 2 to 3 mg, repeated until signs of poisoning subside or signs of intoxication appear.
Children: 0.02 to 0.05 mg/kg/dose every 10 to 20 min until signs of atropic effect are observed, then every 1 to 4 h for at least 24 h.
AtroPen It is recommended that 3 AtroPen auto-injectors be available for use in each person at risk of nerve agent or organophosphate insecticide poisoning: 1 for mild symptoms plus 2 for severe symptoms as described in package insert.
Adults and Children weighing over 90 lb (41 kg) (generally older than 10 yr of age): IM 2 mg.
Children weighing 40 to 90 lb (18 to 41 kg) (generally 4 to 10 yr of age): IM 1 mg.
Children weighing 15 to 40 lb (7 to 18 kg) (generally 6 mo to 4 yr of age): IM 0.5 mg.
Children weighing less than 15 lb (7 kg) (generally younger than 6 mo of age): IM 0.25 mg.
Adults: 1 to 2 drops 0.5% to 1% solution up to 4 times daily or ointment once or twice daily.
Children: 1 to 2 drops 0.5% solution 3 times daily.
Adults: 1 to 2 drops of 1% solution 1 h before refraction examination.
Children: 1 to 2 drops 0.5% solution twice daily 1 to 3 days before refraction examination.
Inhibits action of acetylcholine or other cholinergic stimuli at postganglionic cholinergic receptors, including smooth muscles, secretory glands, and CNS sites.
In the face of life-threatening poisonings by organophosphorous nerve agents and insecticides, there are no absolute contraindications for atropine use. Hypersensitivity to anticholinergics; narrow-angle glaucoma; primary glaucoma or tendency toward glaucoma (ophthalmic); adhesions between iris and lens; prostatic hypertrophy; obstructive uropathy; myocardial ischemia; unstable cardiac status caused by hemorrhage; tachycardia; myasthenia gravis; pyloric or intestinal obstruction; asthma; hyperthyroidism; renal disease; hepatic disease; toxic megacolon; intestinal atony or paralytic ileus.
CV: Altered ST-T waves; systole; atrial arrhythmia; atrial ectopic beats; atrial fibrillation; bigeminal beats; bradycardia; cardiac dilation; cardiac syncope; decreased BP; flattening of T wave; increased BP; intermittent nodal rhythm (no P wave); labile BP; left ventricular failure; MI; nodal extrasystole; palpitations; prolongation of sinus node recovery time; prolonged P wave; prolonged QT interval; retrograde conduction; R on T phenomenon; shortened PR segment; shortened RT duration; supraventricular extrasystole; tachycardia (sinus, supraventricular, junctional); transient AV dissociation; trigeminal beats; ventricular arrhythmia; ventricular extrasystole; ventricular fibrillation; ventricular flutter; ventricular premature contractions; weak or impalpable pulses; widening and flattening of QRS complex.
CNS: Abnormal movements; agitation; amnesia; anxiety; ataxia; Babinski reflex/Chaddock reflex; behavioral changes; coma; confusion; delirium; depression; difficulty concentrating; diminished tendon reflex; dizziness; dysarthria; dysmetria; fatigue; hallucinations; headache; hyperreflexia; hypertonia; insomnia; lethargy; locomotor difficulties; loss of libido; mania; mental disorder; muscle clonus; muscle twitching; opisthotonos; paranoia; restlessness; seizures; sensation of intoxication; somnolence; stupor; tremor; vertigo; weakness; withdrawal behavior.
DERM: Cold skin; cyanosed skin; dermatitis; dry mucous membranes; dry warm skin; erythematous rash; flushing; macular rash; maculopapular rash; oral lesions; popular rash; petechiae rash; salivation; scarlatiniform rash; sweating/moist skin.
EENT: Acute angle-closure glaucoma; blepharitis; blindness; blurred vision; conjunctivitis; cyclophoria; cycloplegia; decreased accommodation; decreased contrast sensitivity; decreased visual acuity; dry conjunctiva; dry eyes; eyelid crusting; heterophoria; irritated eyes; keratoconjunctivitis; mydriasis; photophobia; pupils poorly reactive to light; sicca; strabismus; tearing.
Eczematoid dermatitis; follicular conjunctivitis; vascular congestion, edema, and exudates.
GI: Abdominal distention; abdominal pain; constipation; decreased bowel sounds; decreased food absorption; delayed gastric emptying; distended abdomen; dry mouth; dysphagia; nausea; paralytic ileus; vomiting.
GU: Bed wetting; difficulty in micturition; distended urinary bladder; impotency; urinary hesitancy or retention; urinary urgency.
LABTESTABS: Alpha waves (EEG) blocked upon opening eyes; elevated BUN; elevated erythrocytes; elevated hemoglobin; hyperglycemia; hypoglycemia; hypokalemia; hyponatremia; increase in photic stimulation on EEG; leukocytosis; low hemoglobin; runs of alpha waves on EEG; signs of drowsiness on EEG.
LOCAL: Injection-site reaction.
M/N: Dehydration; failure to feed.
RESP: Breathing difficulty; inspiratory stridor; labored respirations; laryngospasm; pulmonary edema; respiratory failure; shallow respiration; slow respiration; subcostal recession; syncope; tachypnea.
OTHER: Chest pain; excessive thirst; feeling hot; heat intolerance; hyperpyrexia; tongue chewing.
Worsened schizophrenic symptoms; decreased serum haloperidol concentrations.
Other anticholinergic agents
Additive anticholinergic effects.
Decreased antipsychotic effects and increased anticholinergic effects may occur.
Therapeutic Classification: antiarrhythmics
Pharmacologic Classification: anticholinergics, antimuscarinics
Absorption: Well absorbed following oral, subcut, or IM administration.
Distribution: Readily crosses the blood-brain barrier. Crosses the placenta and enters breast milk.
Metabolism/Excretion: Mostly metabolized by the liver; 30–50% excreted unchanged by the kidneys.
Half-life: Children <2 yr: 4–10 hr; Children >2 yr: 1.5–3.5 hr; Adults: 4–5 hr.
|ORAL||30 MINUTE||30-60 MINUTE||4-6 HOUR|
|INTRAMUSCULAR||RAPID||15-50 MINUTE||4-6 HOUR|
|INTRAVENOUS||IMMEDIATE||2-4 MINUTE||4-6 HOUR|