| ATROPINE SULFATE
Classifications: anticholinergic; antimuscarinic; antiarrhythmic; Therapeutic: anticholinergic; antimuscarinic; antiarrhythmic
Pregnancy Category: C
0.4 mg tablets; 0.05 mg/mL, 0.1 mg/mL, 0.3 mg/mL, 0.4 mg/mL, 0.5 mg/mL, 0.8 mg/mL, 1 mg/mL injection
Acts by selectively blocking all muscarinic responses to acetylcholine (ACh), whether excitatory or inhibitory. Antisecretory
action (vagolytic effect) suppresses sweating, lacrimation, salivation, and secretions from nose, mouth, pharynx, and bronchi.
Potent bronchodilator when bronchoconstriction has been induced by parasympathomimetics, and decreases bronchial secretions.
Decreases GI spasm. Produces mydriasis and cycloplegia by blocking responses of iris sphincter muscle and ciliary muscle
of lens to cholinergic stimulation. Blocks vagal impulses to heart with resulting decrease in AV conduction time, increase
in heart rate and cardiac output, and shortened PR interval.
Adjunct in symptomatic treatment of GI disorders (e.g., peptic ulcer, pylorospasm, GI hypermotility, irritable bowel syndrome)
and spastic disorders of biliary tract. Relaxes upper GI tract and colon during hypotonic radiography. Ophthalmic Use: To produce mydriasis and cycloplegia before refraction and for treatment of anterior uveitis and iritis. Preoperative Use: To suppress salivation, perspiration, and respiratory tract secretions; to reduce incidence of laryngospasm, reflex bradycardia
arrhythmia, and hypotension during general anesthesia. Cardiac Uses: For sinus bradycardia or asystole during CPR or that is induced by drugs or toxic substances (e.g., pilocarpine, beta-adrenergic
blockers, organophosphate pesticides, and Amanita mushroom poisoning); for management of selected patients with symptomatic sinus bradycardia and associated hypotension
and ventricular irritability; for diagnosis of sinus node dysfunction and in evaluation of coronary artery disease during
atrial pacing; for management of chronic symptomatic sinus node dysfunction. Other Uses: Oral inhalation for short-term treatment and prevention of bronchospasms associated with asthma, bronchitis, and COPD and
as drying agent in upper respiratory infection. Adjunctive therapy for hypermotility of GI tract.
Hypersensitivity to belladonna alkaloids; synechiae; angle-closure glaucoma; parotitis; obstructive uropathy (e.g., bladder
neck obstruction caused by prostatic hypertrophy); intestinal atony, paralytic ileus, achalasia, pyloric stenosis, obstructive
diseases of GI tract, severe ulcerative colitis, toxic megacolon; tachycardia secondary to cardiac insufficiency or thyrotoxicosis;
acute hemorrhage; acute MI; myasthenia gravis; pregnancy (category C).
Myocardial infarction, hypertension, hypotension; coronary artery disease, CHF, tachyarrhythmias; gastric ulcer, GI infections,
hiatal hernia with reflux esophagitis; hyperthyroidism; COPD; autonomic neuropathy; hepatic or renal disease; older adults;
debilitated patients; children <6 y of age; Down syndrome; autonomic neuropathy, spastic paralysis, brain damage in children;
patients exposed to high environmental temperatures; patients with fever.
Route & Dosage
Adult: IV/IM/SC 0.40.6 mg 3060 min before surgery
Child: IV/IM/SC <5 kg, 0.04 mg/kg; >5 kg, 0.03 mg/kg 3060 min before surgery (max: 0.4 mg)
Adult: IV/IM 1 mg q23 min (max: 3 mg)
Child: IV/IM 0.010.03 mg/kg for 12 doses
Adult: IV/IM 12 mg q560min until muscarinic signs and symptoms subside (may need up to 50 mg)
Child: IV/IM 0.05 mg/kg q1030min until muscarinic signs and symptoms subside
Adult: Inhalation 0.025 mg/kg diluted with 35 mL saline, via nebulizer 34 times daily (max: 2.5 mg/d)
Child: Inhalation 0.030.05 mg/kg diluted with 35 mL saline, via nebulizer 34 times daily
Adult/Child: Ophthalmic 12 drops of solution or small amount of ointment in eye up to t.i.d.
Adult: Ophthalmic 1 drop of solution or small amount of ointment in eye 1 h before the procedure
Child: Ophthalmic 12 drops in eye b.i.d. for 13 d prior to procedure or a small amount of ointment in conjunctival sac t.i.d.
for 13 d prior to procedure with last dose applied several hours before the procedure
PREPARE: Direct: Give undiluted or diluted in up to 10 mL of sterile water.
ADMINISTER: Direct: Give 1 mg or fraction thereof over 1 min directly into a Y-site.
INCOMPATIBILITIES Solution/additive: Pantoprazole.
- Store at room temperature 15°30° C (59°86° F) in protected airtight, light-resistant containers
unless otherwise directed by manufacturer.
Adverse Effects (≥1%)CNS:
Headache, ataxia, dizziness, excitement, irritability, convulsions, drowsiness, fatigue
, weakness; mental depression
disorientation, hallucinations. CV:
Hypertension or hypotension, ventricular tachycardia, palpitation, paradoxical bradycardia, AV dissociation, atrial or ventricular fibrillation. GI:
Dry mouth with thirst, dysphagia, loss of taste; nausea, vomiting, constipation
, delayed gastric emptying, antral stasis,
paralytic ileus. Urogenital:
Urinary hesitancy and retention, dysuria, impotence. Skin:
Flushed, dry skin; anhidrosis, rash, urticaria, contact dermatitis, allergic conjunctivitis
, fixed-drug eruption. Special Senses:
Mydriasis, blurred vision, photophobia, increased intraocular pressure, cycloplegia, eye dryness, local redness.
Diagnostic Test Interference
Upper GI series: Findings may require qualification because of anticholinergic effects of atropine (reduced gastric motility and delayed
gastric emptying). PSP excretion test: Atropine may decrease urinary excretion of PSP (phenolsulfonphthalein).
InteractionsDrug: Amantadine, antihistamines
, tricyclic antidepressants
, quinidine, disopyramide, procainamide
add to anticholinergic effects. Levodopa
effects decreased. Methotrimeprazine
may precipitate extrapyramidal effects. Antipsychotic effects of phenothiazines
are decreased due to decreased absorption.
Well absorbed from all administration sites. Peak effect: 30 min IM, 24 min IV, 12 h SC, 1.54 h inhalation,
3040 min topical. Duration:
Inhibition of salivation 4 h; mydriasis 714 d. Distribution:
In most body tissues; crosses bloodbrain barrier and placenta. Metabolism:
In liver. Elimination:
7794% in urine in 24 h. Half-Life:
Assessment & Drug Effects
- Monitor vital signs. HR is a sensitive indicator of patient's response to atropine. Be alert to changes in quality, rate,
and rhythm of HR and respiration and to changes in BP and temperature.
- Initial paradoxical bradycardia following IV atropine usually lasts only 12 min; it most likely occurs when IV is
administered slowly (more than 1 min) or when small doses (less than 0.5 mg) are used. Postural hypotension occurs when patient
ambulates too soon after parenteral administration.
- Note: Frequent and continued use of eye preparations, as well as overdosage, can have systemic effects. Some atropine deaths have
resulted from systemic absorption following ocular administration in infants and children.
- Monitor I&O, especially in older adults and patients who have had surgery (drug may contribute to urinary retention). Palpate
lower abdomen for distention. Have patient void before giving atropine.
- Monitor CNS status. Older adults and debilitated patients sometimes manifest drowsiness or CNS stimulation (excitement, agitation,
confusion) with usual doses of drug or other belladonna alkaloids. In addition to dosage adjustment, side rails and supervision
of ambulation may be indicated.
- Monitor infants, small children, and older adults for "atropine fever" (hyperpyrexia due to suppression of perspiration
and heat loss), which increases the risk of heatstroke.
- Note: Intraocular tension and depth of anterior chamber should be determined before and during therapy with ophthalmic preparations
to avoid glaucoma attacks (ophthalmic solutions and ointments are available in various strengths).
- Patients receiving atropine via inhalation sometimes manifest mild CNS stimulation with doses in excess of 5 mg and mental
depression and other mental disturbances with larger doses.
Patient & Family Education
- Follow measures to relieve dry mouth: adequate hydration; small, frequent mouth rinses with tepid water; meticulous mouth
and dental hygiene; gum chewing or sucking sugarless sourballs.
- Note: Drug causes drowsiness, sensitivity to light, blurring of near vision, and temporarily impairs ability to judge distance.
Avoid driving and other activities requiring visual acuity and mental alertness.
- Discontinue ophthalmic preparations and notify physician if eye pain, conjunctivitis, palpitation, rapid pulse, or dizziness