Atropine

Indications
 Parenteral
Premedication in balanced anaesthesia
Adult: 300-600 mcg IM/SC 30-60 minutes before anaesthesia. Alternatively, 300-600 mcg IV immediately before induction of anaesthesia.
Child: >20 kg: 300-600 mcg; 12-16 kg: 300 mcg; 7-9 kg: 200 mcg; >3 kg: 100 mcg. Doses to be given via IM/SC admin 30-60 minutes before anaesthesia.
Parenteral
Organophosphorus poisoning
Adult: 2 mg IV/IM, every 10-30 minutes until muscarinic effects disappear or atropine toxicity appears. In severe cases, dose can be given as often as every 5 minutes. In moderate to severe poisoning, a state of atropinisation is maintained for at least 2 days and continued for as long as symptoms are present.
Child: 20 mcg/kg given every 5-10 minutes.
Parenteral
Poisoning or overdosage with compounds having muscarinic actions
Adult: 0.6-1 mg IV/IM/SC, repeated every 2 hr.
Intravenous
Bradycardia
Adult: 500 mcg every 3-5 minutes. Total: 3 mg.
Max Dosage: 0.04 mg/kg body weight.
Ophthalmic
Inflammatory eye disorders
Adult: Instill 1-2 drops of a 0.5-1% solution up to 4 times daily.
Child: As sulfate: Instill 1-2 drops of a 0.5% soln (or 1 drop of a 1% solution) up to tid.
Ophthalmic
Eye refraction
Adult: Instill 1 drop of a 1% solution bid for 1-2 days before the procedure, or on a single occasion 1 hr before the procedure.
Child: As sulfate: Instill 1 or 2 drops of a 0.5% soln (or 1 drop of a 1% solution) bid for 1-3 days before the procedure, with a further dose given 1 hr before the procedure.

Incompatibility: Incompatible with hydroxybenzoate preservatives.
Contraindications
 Glaucoma, chronic respiratory disease, sick sinus syndrome, thyrotoxicosis, cardiac failure, pyloric stenosis, prostatic hypertrophy.
Warnings / Precautions
 Reflux oesophagitis, elderly, infants and children. Pregnancy.
Adverse Reactions
 Dry mouth, dysphagia, constipation, flushing and dryness of skin, tachycardia, palpitations, arrhythmias, mydriasis, photophobia, cycloplegia, raised intraocular pressure. Toxic doses cause tachycardia, hyperpyrexia, restlessness, confusion, excitement, hallucinations, delirium and may progress to circulatory failure and resp depression. Eye drops: Systemic toxicity esp in children, on prolonged use may lead to irritation, hyperaemia, oedema and conjunctivitis. Increased intraocular pressure. Inhalation: Dryness of mouth, throat.
Potentially Fatal: Atrial arrhythmias, AV dissociation, multiple ventricular ectopics.
Overdose Reactions
 May cause hyperthermia, hypertension, increased respiratory rate, nausea and vomiting. May also lead to CNS stimulation. Severe intoxication may lead to CNS depression, coma, respiratory failure and death.
Drug Interactions
 Additive anticholinergic effects with quinidine, antidepressants and some antihistamines.
See Below for More atropine Drug Interactions
Mechanism of Actions
 Atropine is an anticholinergic agent which competitively blocks the muscarinic receptors in peripheral tissues such as the heart, intestines, bronchial muscles, iris and secretory glands. Some central stimulation may occur. Atropine abolishes bradycardia and reduces heart block due to vagal activity. Smooth muscles in the bronchi and gut are relaxed while glandular secretions are reduced. It also has mydriatic and cycloplegic effect.
Absorption: Readily absorbed from the GI tract; also absorbed from mucous membranes, eye, and through intact skin.
Distribution: Distributes throughout the body and crosses the blood-brain barrier and placenta.
Metabolism: Incomplete metabolism in the liver.
Excretion: Excreted in urine as unchanged drug and metabolites. Half-life reported to be 4 hr.
Administration
 May be taken with or without food. (Take w/ food or water.)
Storage Conditions
 Intravenous: Store at 15-30°C. Ophthalmic: Store at 15-30°C. Parenteral: Store at 15-30°C.
ATC Classification
 A03BA01 - atropine ; Belongs to the class of belladonna alkaloids, tertiary amines. Used in the treatment of functional gastrointestinal disorders.
S01FA01 - atropine ; Belongs to the class of anticholinergics used as mydriatics and cycloplegics.
Storage
 Intravenous: Store at 15-30°C. Ophthalmic: Store at 15-30°C. Parenteral: Store at 15-30°C.
Available As
  • Atropine Sulphate 0.025 mg
  • Atropine Methonitrate 0.14% w/v
  • Atropine Sulphate 0.25 mg
  • Atropine Sulphate 0.3 mg
  • Atropine Sulphate 0.32 mg
  • Atropine Sulphate 0.6 mg
  • Atropine 0.6 mg
  • Atropine Sulphate 1%
  • Atropine 1%
  • Atropine Sulphate 1% w/v
  • Atropine 1% w/v
  • Atropine Sulphate 1% w/w
  • Atropine Sulphate 1.0%

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