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atropine IV/IM (Rx)Brand and Other Names:AtroPen

 
 
 

Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

intramuscular device

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

injectable solution

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

Anesthesia Premedication

0.4-0.6 mg IV/IM/SC 30-60 minutes before anesthesia; repeat q4-6hr PRN

Sinus Bradycardia (ACLS)

0.5-1 mg or 0.04 mg/kg IV q5min, no more than 3 mg

ET: Some experts suggest 2-3 times IV dose diluted in3- 5 mL sterile water for injection/NS (sterile water for injection may facilitate absorption better than NS, but may produce more negative effect on arterial oxygen pressure)

Bronchospasm

0.025 mg/kg in 2.5 mL NS q6-8hr via nebulizer; no more than 2.5 mg/dose 

Asystole/Pulseless Electrical Activity (ACLS)

1 mg IV q3-5min PRN if asystole persist up to 0.04 mg/kg

Cholinesterase Inhibitors (Organophosphates, Carbamates)

AtroPen: 2 mg/dose IM

Mild symptoms: 1 AtroPen dose

If severe symptoms develop (eg, strange or confused behavior, wheezing, sialorrhea, muscle fasciculations, involuntary urination/defecation, convulsion, unconsciousness) give 2 additional AtroPen injections in rapid succession 10 minutes after initial dose

Initial severe symptoms: Give 3 AtroPen doses in rapid succession

Dosage Forms & Strengths

intramuscular device

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

injectable solution

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

Anesthesia Premedication

<5 kg: 0.02 mg/kg/dose 30-60 minutes preop; then q4-6hr PRN 

>5 kg: 0.01-0.02 mg/kg IV/IM/SC; no more than 0.4 mg

Sinus Bradycardia

0.02 mg/kg IV/IO q5min for 2-3 doses PRN; single dose no less than: 0.1 no more than 0.5 mg (children), 1 mg (adolescents) 

Total: No more than: 1 mg (children), 2 mg (adolescents)

ET: Some experts suggest 0.03 mg/kg, diluted in NS

Bronchospasm

0.025-0.05 mg/kg in 2.5 mL NS q6-8hr via nebulizer; no more than 2.5 mg/dose 

Organophosphate or Carbamate Poisoning

IV: 0.03-0.05 mg/kg IV/IM/IO/ET q10-20min PRN to effect; then q1-4hr for at least 24 hours 

IM (AtroPen):

Mild symptoms: 1 AtroPen dose (see specific dose for weight below)

If severe symptoms develop (eg, strange or confused behavior, wheezing, sialorrhea, muscle fasciculations, involuntary urination/defecation, convulsion, unconsciousness) give 2 additional AtroPen injections in rapid succession 10 minutes after initial dose

Severe symptoms

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

Interaction Checker

atropine IV/IM and

No Results

     
     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

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            Adverse Effects

            Frequency Not Defined

            Anticholinergic symptoms (mydriasis, hyperthermia, tachycardia, cardiac arrhythmia, delayed gastric emptying)

            Ataxia

            Fever

            Headache

            Insomnia

            Dry mouth

            Anhidrosis

            Urticaria

            Urinary hesitancy

            Dry skin

            Blurred vision

            Cycloplegia

            Photophobia

            Anhidrosis

            Palpitation

            Dyspnea

            Paralytic ileus

            Pulmonary edema

            Nasal dryness

            Xerophthalmia

            Constipation

            May increase IOP in predisposed patients

            May cause CNS disturbances (especially in pediatric patients)

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            Warnings

            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

            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

            Heat prostration can occur in high environmental temperature

            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 precipitate acute glaucoma

            May convert partial organic pyloric stenosis into complete obstruction

            May lead to complete urinary retention in patients with prostatic hypertrophy

            May cause inspissation of bronchial secretions and formation of viscid plugs in patients with chronic lung disease

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            Pregnancy & Lactation

            Pregnancy Category: C

            Lactation: Trace amounts enter breast milk; use with caution (AAP Committee states "compatible with nursing")

            Pregnancy Categories

            A:Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B:May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C:Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D:Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X:Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA:Information not available.

            more...
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            Pharmacology

            Mechanism of Action

            Competitively inhibits action of ACh on autonomic effectors innervated by postganglionic nerves; reverses muscarinic effects of cholinergic poisoning caused by agents with cholinesterase inhibitor activity by acting as a competitive antagonist of acetylcholine ast muscarinic receptors; blocks action of acetylcholiine at parsympathetic sites in secretory glands, and CNS; inhibits salivation, tracheobronchial secretions, bradycardia, hypotension

            Antimuscarinic agent

            Pharmacokinetics

            Half-Life: 2-3 hr (>2 years and adults); 7 hr (<2 years); 10 hr (65-75 years)

            Peak Plasma Time: 3 min (IM)

            Onset: Rapid (IV/IM)

            Bronchodilation: Within 15 min; max within 15 min-1.5 hr (oral inhalation)

            Distribution: Throughout the body; crosses blood brain barrier

            Absorption: Principally from the upper small intestine

            Metabolites: Tropic acid, tropine, & possibly esters of tropic acid and glucuronide conjugates

            Metabolism: Liver via enzymatic hydrolysis

            Excretion: Urine (30-50%); small amounts may also be eliminated in expired air as carbon dioxide & in feces

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            Administration

            IV Incompatibilities

            Additive: floxacillin

            Syringe: cimetidine w/ pentobarbital

            Y-site: thiopental

            Not spec: ampicillin, diazepam, epinephrine, norepinephrine

            IV Compatibilities

            Additive: dobutamine, furosemide, meropenem, netilmicin, Na bicarb, verapamil

            Syringe: (partial list) cimetidine, fentanyl, glycopyrrolate, heparin, hydroxyzine, meperidine, morphine, pentobarbital

            Y-site: abciximab, amiodarone, argatroban, etomidate, famotidine, fenoldopam, fentanyl, heparin, hydrocortisone, hydromorphone, inamrinone, meropenem, methadone, morphine, nafcillin, KCl, propofol, sufentanil, tirofiban, vit B/C

            IV Administration

            SC, IM, IV

            Give into large vein or IV tubing over 1-2 min

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            Images

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            Formulary

            FormularyPatient Discounts

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            The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
            ST Step Therapy
            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
            OR Other Restrictions
            Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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