Dosing & Uses
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
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
Organophosphate or Carbamate (Cholinesterase Inhibitors) Poisoning
Symptoms of organophosphate and/or carbamate poisoning
-
Mild symptoms
- Blurred vision or miosis
- Unexplained excessive lacrimation
- Unexplained excessive nasopharyngeal secretions
- Increased salivation
- Chest tightness, difficulty breathing, wheezing, or coughing
- Tremors throughout the body or muscular twitching
- Nausea, vomiting, abdominal cramping, or diarrhea
- Tachycardia or bradycardia
-
Severe symptoms
- Altered mental status
- Loss of consciousness
- Respiratory distress
- Excessive secretions from the lungs/airway
- Severe muscular twitching, generalized weakness or paralysis
- Involuntary urination and/or defecation
- Convulsions or seizures
IM Autoinjector
Two or more mild symptoms of nerve agent (nerve gas) or insecticide exposure: Administer 1 injection (2 mg) IM
Wait 10-15 minutes for drug to take effect; if, after 10-15 minutes, patient does not develop any severe symptoms, no additional injections recommended
If after first dose, patient develops severe symptoms, administer 2 additional injections IM in rapid succession
If possible, a person other than patient should administer second and third 2 mg autoinjector
If patient is either unconscious or has any severe symptoms, immediately administer 3 injections intramuscularly into patient’s mid-lateral outer thigh in rapid succession
Antidotes should not be relied upon solely to provide complete protection from chemical nerve agents and insecticide poisoning
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
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 (Cholinesterase Inhibitors) Poisoning
Symptoms of organophosphate and/or carbamate poisoning
-
Mild symptoms
- Blurred vision or miosis
- Unexplained excessive lacrimation
- Unexplained excessive nasopharyngeal secretions
- Increased salivation
- Chest tightness, difficulty breathing, wheezing, or coughing
- Tremors throughout the body or muscular twitching
- Nausea, vomiting, abdominal cramping, or diarrhea
- Tachycardia or bradycardia
-
Severe symptoms
- Altered mental status Loss of consciousness
- Respiratory distress
- Excessive secretions from the lungs/airway
- Severe muscular twitching, generalized weakness or paralysis
- Involuntary urination and/or defecation
- Convulsions or seizures
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 Autoinjector
Two or more mild symptoms of nerve agent (nerve gas) or insecticide exposure: Administer one 1 injection (2 mg) IM
Wait 10-15 minutes for drug to take effect; if, after 10-15 minutes, patient does not develop any severe symptoms, no additional injections recommended
If after first dose, patient develops severe symptoms, administer 2 additional injections IM in rapid succession
If possible, a person other than patient should administer second and third 2 mg autoinjector
If patient is either unconscious or has any severe symptoms, immediately administer 3 injections intramuscularly into patient’s mid-lateral outer thigh in rapid succession
Antidotes should not be relied upon solely to provide complete protection from chemical nerve agents and insecticide poisoning
See specific dose for weight below
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
Interactions
Interaction Checker
No Results
Contraindicated
Serious - Use Alternative
Significant - Monitor Closely
Minor
Contraindicated (0)
Serious - Use Alternative (3)
- glycopyrronium tosylate topical
glycopyrronium tosylate topical, atropine IV/IM. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Coadministration of glycopyrronium tosylate topical with other anticholinergic medications may result in additive anticholinergic adverse effects.
- pramlintide
pramlintide, atropine IV/IM. Either increases effects of the other by pharmacodynamic synergism. Contraindicated. Synergistic inhibition of GI motility.
- umeclidinium bromide/vilanterol inhaled
atropine IV/IM, umeclidinium bromide/vilanterol inhaled. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Concomitant use with other anticholinergic-containing drugs may lead to additive anticholinergic adverse effects.
Monitor Closely (93)
- aclidinium
atropine IV/IM and aclidinium both decrease cholinergic effects/transmission. Use Caution/Monitor.
- amantadine
atropine IV/IM, amantadine. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Enhanced CNS side effects.
- amitriptyline
atropine IV/IM and amitriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.
- amoxapine
atropine IV/IM and amoxapine both decrease cholinergic effects/transmission. Use Caution/Monitor.
- anticholinergic/sedative combos
anticholinergic/sedative combos and atropine IV/IM both decrease cholinergic effects/transmission. Use Caution/Monitor.
- aripiprazole
aripiprazole increases effects of atropine IV/IM by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.
atropine IV/IM decreases levels of aripiprazole by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
atropine IV/IM decreases levels of aripiprazole by pharmacodynamic antagonism. Use Caution/Monitor. - atracurium
atracurium and atropine IV/IM both decrease cholinergic effects/transmission. Use Caution/Monitor.
- belladonna alkaloids
atropine IV/IM and belladonna alkaloids both decrease cholinergic effects/transmission. Use Caution/Monitor.
- belladonna and opium
atropine IV/IM and belladonna and opium both decrease cholinergic effects/transmission. Use Caution/Monitor.
- benperidol
benperidol increases effects of atropine IV/IM by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.
atropine IV/IM decreases levels of benperidol by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
atropine IV/IM decreases levels of benperidol by pharmacodynamic antagonism. Use Caution/Monitor. - benztropine
atropine IV/IM and benztropine both decrease cholinergic effects/transmission. Use Caution/Monitor.
- bethanechol
bethanechol increases and atropine IV/IM decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor. .
- carbachol
carbachol increases and atropine IV/IM decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor. .
- cevimeline
cevimeline increases and atropine IV/IM decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor. .
- chlorpromazine
chlorpromazine increases effects of atropine IV/IM by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.
atropine IV/IM decreases levels of chlorpromazine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
atropine IV/IM decreases levels of chlorpromazine by pharmacodynamic antagonism. Use Caution/Monitor. - cisatracurium
atropine IV/IM and cisatracurium both decrease cholinergic effects/transmission. Use Caution/Monitor.
- clomipramine
atropine IV/IM and clomipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.
- clozapine
clozapine increases effects of atropine IV/IM by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.
atropine IV/IM decreases levels of clozapine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
atropine IV/IM decreases levels of clozapine by pharmacodynamic antagonism. Use Caution/Monitor. - cyclizine
atropine IV/IM and cyclizine both decrease cholinergic effects/transmission. Use Caution/Monitor.
- cyclobenzaprine
atropine IV/IM and cyclobenzaprine both decrease cholinergic effects/transmission. Use Caution/Monitor.
- darifenacin
atropine IV/IM and darifenacin both decrease cholinergic effects/transmission. Use Caution/Monitor.
- desipramine
atropine IV/IM and desipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.
- dicyclomine
atropine IV/IM and dicyclomine both decrease cholinergic effects/transmission. Use Caution/Monitor.
- digoxin
atropine IV/IM increases levels of digoxin by unknown mechanism. Use Caution/Monitor.
- diphenhydramine
atropine IV/IM and diphenhydramine both decrease cholinergic effects/transmission. Use Caution/Monitor.
- donepezil
donepezil increases and atropine IV/IM decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor. .
- dosulepin
atropine IV/IM and dosulepin both decrease cholinergic effects/transmission. Use Caution/Monitor.
- doxepin
atropine IV/IM and doxepin both decrease cholinergic effects/transmission. Use Caution/Monitor.
- droperidol
droperidol increases effects of atropine IV/IM by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.
atropine IV/IM decreases levels of droperidol by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
atropine IV/IM decreases levels of droperidol by pharmacodynamic antagonism. Use Caution/Monitor. - echothiophate iodide
echothiophate iodide increases and atropine IV/IM decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor. .
- fesoterodine
atropine IV/IM and fesoterodine both decrease cholinergic effects/transmission. Use Caution/Monitor.
- flavoxate
atropine IV/IM and flavoxate both decrease cholinergic effects/transmission. Use Caution/Monitor.
- fluphenazine
fluphenazine increases effects of atropine IV/IM by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.
atropine IV/IM decreases levels of fluphenazine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
atropine IV/IM decreases levels of fluphenazine by pharmacodynamic antagonism. Use Caution/Monitor. - galantamine
galantamine increases and atropine IV/IM decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor. .
- glycopyrrolate
atropine IV/IM and glycopyrrolate both decrease cholinergic effects/transmission. Use Caution/Monitor.
- glycopyrrolate inhaled
atropine IV/IM and glycopyrrolate inhaled both decrease cholinergic effects/transmission. Use Caution/Monitor.
- haloperidol
haloperidol increases effects of atropine IV/IM by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.
atropine IV/IM decreases levels of haloperidol by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
atropine IV/IM decreases levels of haloperidol by pharmacodynamic antagonism. Use Caution/Monitor. - henbane
atropine IV/IM and henbane both decrease cholinergic effects/transmission. Use Caution/Monitor.
- homatropine
atropine IV/IM and homatropine both decrease cholinergic effects/transmission. Use Caution/Monitor.
- huperzine A
huperzine A increases and atropine IV/IM decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor. .
- hyoscyamine
atropine IV/IM and hyoscyamine both decrease cholinergic effects/transmission. Use Caution/Monitor.
- iloperidone
iloperidone increases effects of atropine IV/IM by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.
atropine IV/IM decreases levels of iloperidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
atropine IV/IM decreases levels of iloperidone by pharmacodynamic antagonism. Use Caution/Monitor. - imipramine
atropine IV/IM and imipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.
- ipratropium
atropine IV/IM and ipratropium both decrease cholinergic effects/transmission. Use Caution/Monitor.
- levodopa
atropine IV/IM, levodopa. Other (see comment). Use Caution/Monitor. Comment: Anticholinergic agents may enhance the therapeutic effects of levodopa; however, anticholinergic agents can exacerbate tardive dyskinesia. In high dosage, anticholinergics may decrease the effects of levodopa by delaying its GI absorption. .
- lofepramine
atropine IV/IM and lofepramine both decrease cholinergic effects/transmission. Use Caution/Monitor.
- loxapine
loxapine increases effects of atropine IV/IM by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.
atropine IV/IM decreases levels of loxapine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
atropine IV/IM decreases levels of loxapine by pharmacodynamic antagonism. Use Caution/Monitor. - loxapine inhaled
loxapine inhaled increases effects of atropine IV/IM by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.
atropine IV/IM decreases levels of loxapine inhaled by pharmacodynamic antagonism. Use Caution/Monitor. - maprotiline
atropine IV/IM and maprotiline both decrease cholinergic effects/transmission. Use Caution/Monitor.
- meclizine
atropine IV/IM and meclizine both decrease cholinergic effects/transmission. Use Caution/Monitor.
- methscopolamine
atropine IV/IM and methscopolamine both decrease cholinergic effects/transmission. Use Caution/Monitor.
- neostigmine
neostigmine increases and atropine IV/IM decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor. .
- nortriptyline
atropine IV/IM and nortriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.
- olanzapine
olanzapine increases effects of atropine IV/IM by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.
atropine IV/IM decreases levels of olanzapine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
atropine IV/IM decreases levels of olanzapine by pharmacodynamic antagonism. Use Caution/Monitor. - onabotulinumtoxinA
atropine IV/IM and onabotulinumtoxinA both decrease cholinergic effects/transmission. Use Caution/Monitor.
- orphenadrine
atropine IV/IM and orphenadrine both decrease cholinergic effects/transmission. Use Caution/Monitor.
- oxybutynin
atropine IV/IM and oxybutynin both decrease cholinergic effects/transmission. Use Caution/Monitor.
- oxybutynin topical
atropine IV/IM and oxybutynin topical both decrease cholinergic effects/transmission. Use Caution/Monitor.
- oxybutynin transdermal
atropine IV/IM and oxybutynin transdermal both decrease cholinergic effects/transmission. Use Caution/Monitor.
- paliperidone
paliperidone increases effects of atropine IV/IM by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.
atropine IV/IM decreases levels of paliperidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
atropine IV/IM decreases levels of paliperidone by pharmacodynamic antagonism. Use Caution/Monitor. - pancuronium
atropine IV/IM and pancuronium both decrease cholinergic effects/transmission. Use Caution/Monitor.
- perphenazine
perphenazine increases effects of atropine IV/IM by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.
atropine IV/IM decreases levels of perphenazine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
atropine IV/IM decreases levels of perphenazine by pharmacodynamic antagonism. Use Caution/Monitor. - physostigmine
physostigmine increases and atropine IV/IM decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor. .
- pilocarpine
pilocarpine increases and atropine IV/IM decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor. .
- pilocarpine ophthalmic
pilocarpine ophthalmic increases and atropine IV/IM decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor. .
- pimozide
pimozide increases effects of atropine IV/IM by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.
atropine IV/IM decreases levels of pimozide by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
atropine IV/IM decreases levels of pimozide by pharmacodynamic antagonism. Use Caution/Monitor. - pralidoxime
atropine IV/IM and pralidoxime both decrease cholinergic effects/transmission. Use Caution/Monitor.
- prochlorperazine
prochlorperazine increases effects of atropine IV/IM by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.
atropine IV/IM decreases levels of prochlorperazine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
atropine IV/IM decreases levels of prochlorperazine by pharmacodynamic antagonism. Use Caution/Monitor. - promethazine
promethazine increases effects of atropine IV/IM by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.
- propantheline
atropine IV/IM and propantheline both decrease cholinergic effects/transmission. Use Caution/Monitor.
- protriptyline
atropine IV/IM and protriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.
- pyridostigmine
pyridostigmine increases and atropine IV/IM decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor. .
- quetiapine
quetiapine increases effects of atropine IV/IM by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.
atropine IV/IM decreases levels of quetiapine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
atropine IV/IM decreases levels of quetiapine by pharmacodynamic antagonism. Use Caution/Monitor. - rapacuronium
atropine IV/IM and rapacuronium both decrease cholinergic effects/transmission. Use Caution/Monitor.
- rimantadine
atropine IV/IM, rimantadine. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Enhanced CNS side effects.
- risperidone
risperidone increases effects of atropine IV/IM by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.
atropine IV/IM decreases levels of risperidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
atropine IV/IM decreases levels of risperidone by pharmacodynamic antagonism. Use Caution/Monitor. - rivastigmine
rivastigmine increases and atropine IV/IM decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor. .
- rocuronium
atropine IV/IM and rocuronium both decrease cholinergic effects/transmission. Use Caution/Monitor.
- scopolamine
atropine IV/IM and scopolamine both decrease cholinergic effects/transmission. Use Caution/Monitor.
- solifenacin
atropine IV/IM and solifenacin both decrease cholinergic effects/transmission. Use Caution/Monitor.
- succinylcholine
succinylcholine increases and atropine IV/IM decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor. .
- thioridazine
thioridazine increases effects of atropine IV/IM by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.
atropine IV/IM decreases levels of thioridazine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
atropine IV/IM decreases levels of thioridazine by pharmacodynamic antagonism. Use Caution/Monitor. - thiothixene
thiothixene increases effects of atropine IV/IM by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.
atropine IV/IM decreases levels of thiothixene by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
atropine IV/IM decreases levels of thiothixene by pharmacodynamic antagonism. Use Caution/Monitor. - tiotropium
atropine IV/IM and tiotropium both decrease cholinergic effects/transmission. Use Caution/Monitor.
- tolterodine
atropine IV/IM and tolterodine both decrease cholinergic effects/transmission. Use Caution/Monitor.
- trazodone
atropine IV/IM and trazodone both decrease cholinergic effects/transmission. Use Caution/Monitor.
- trifluoperazine
trifluoperazine increases effects of atropine IV/IM by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.
atropine IV/IM decreases levels of trifluoperazine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
atropine IV/IM decreases levels of trifluoperazine by pharmacodynamic antagonism. Use Caution/Monitor. - trihexyphenidyl
atropine IV/IM and trihexyphenidyl both decrease cholinergic effects/transmission. Use Caution/Monitor.
- trimipramine
atropine IV/IM and trimipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.
- trospium chloride
atropine IV/IM and trospium chloride both decrease cholinergic effects/transmission. Use Caution/Monitor.
- umeclidinium bromide
umeclidinium bromide and atropine IV/IM both decrease cholinergic effects/transmission. Use Caution/Monitor. If possible, avoid coadministration of additional anticholinergic agents
- vecuronium
atropine IV/IM and vecuronium both decrease cholinergic effects/transmission. Use Caution/Monitor.
- ziprasidone
ziprasidone increases effects of atropine IV/IM by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.
atropine IV/IM decreases levels of ziprasidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
atropine IV/IM decreases levels of ziprasidone by pharmacodynamic antagonism. Use Caution/Monitor.
Minor (26)
- amantadine
atropine IV/IM increases levels of amantadine by unknown mechanism. Minor/Significance Unknown.
- amitriptyline
amitriptyline increases levels of atropine IV/IM by unknown mechanism. Minor/Significance Unknown.
- amoxapine
amoxapine increases levels of atropine IV/IM by unknown mechanism. Minor/Significance Unknown.
- atenolol
atropine IV/IM increases levels of atenolol by unknown mechanism. Minor/Significance Unknown.
- chlorpromazine
chlorpromazine increases toxicity of atropine IV/IM by unknown mechanism. Minor/Significance Unknown.
- clomipramine
clomipramine increases levels of atropine IV/IM by unknown mechanism. Minor/Significance Unknown.
- desipramine
desipramine increases levels of atropine IV/IM by unknown mechanism. Minor/Significance Unknown.
- dimenhydrinate
dimenhydrinate increases toxicity of atropine IV/IM by pharmacodynamic synergism. Minor/Significance Unknown. Additive anticholinergic effects.
- donepezil
donepezil decreases effects of atropine IV/IM by pharmacodynamic antagonism. Minor/Significance Unknown.
- doxepin
doxepin increases levels of atropine IV/IM by unknown mechanism. Minor/Significance Unknown.
- fluphenazine
fluphenazine increases toxicity of atropine IV/IM by unknown mechanism. Minor/Significance Unknown.
- galantamine
galantamine decreases effects of atropine IV/IM by pharmacodynamic antagonism. Minor/Significance Unknown.
- imipramine
imipramine increases levels of atropine IV/IM by unknown mechanism. Minor/Significance Unknown.
- lofepramine
lofepramine increases levels of atropine IV/IM by unknown mechanism. Minor/Significance Unknown.
- maprotiline
maprotiline increases levels of atropine IV/IM by unknown mechanism. Minor/Significance Unknown.
- nortriptyline
nortriptyline increases levels of atropine IV/IM by unknown mechanism. Minor/Significance Unknown.
- perphenazine
perphenazine increases toxicity of atropine IV/IM by unknown mechanism. Minor/Significance Unknown.
- prochlorperazine
prochlorperazine increases toxicity of atropine IV/IM by unknown mechanism. Minor/Significance Unknown.
- promazine
promazine increases toxicity of atropine IV/IM by unknown mechanism. Minor/Significance Unknown.
- promethazine
promethazine increases toxicity of atropine IV/IM by unknown mechanism. Minor/Significance Unknown.
- protriptyline
protriptyline increases levels of atropine IV/IM by unknown mechanism. Minor/Significance Unknown.
- rimantadine
rimantadine increases effects of atropine IV/IM by pharmacodynamic synergism. Minor/Significance Unknown.
- thioridazine
thioridazine increases toxicity of atropine IV/IM by unknown mechanism. Minor/Significance Unknown.
- trazodone
trazodone increases levels of atropine IV/IM by unknown mechanism. Minor/Significance Unknown.
- trifluoperazine
trifluoperazine increases toxicity of atropine IV/IM by unknown mechanism. Minor/Significance Unknown.
- trimipramine
trimipramine increases levels of atropine IV/IM by unknown mechanism. Minor/Significance Unknown.
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)
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
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 of
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 & Lactation
Pregnancy
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
Lactation
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
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.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, and 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 and in feces
Administration
IV Incompatibilities
Additive: floxacillin
Syringe: cimetidine with 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
Give into large vein or IV tubing over 1-2 min
Autoinjector
Should have available three (3) autoinjectors, one for mild symptoms plus 2 for severe symptoms, for use in each patient at risk for nerve agent or organophosphate insecticide poisoning
Only administer to patients experiencing symptoms of organophosphorus poisoning in a situation where exposure is known or suspected
The autoinjector is intended as an initial treatment of muscarinic symptoms of insecticide or nerve agent poisonings as soon as symptoms appear; definitive medical care should be sought immediately
Not to be administered until cyanosis has been overcome; atropine may produce ventricular fibrillation and possible seizures in presence of hypoxia
To be used by persons who have had adequate training in recognition and treatment of nerve agent or insecticide intoxication; may be administered by a caregiver or by self-administration if a trained provider is not available
Close supervision of all treated patients indicated for at least 48 to 72 hours
In severe poisonings, concurrent administration of an anticonvulsant (preferably a benzodiazepine) may be warranted if seizure is suspected in the unconscious individual because overt jerking may not be apparent because of the effects of the poison
In poisonings caused by organophosphorous nerve agents and insecticides it may also be helpful to concurrently administer a cholinesterase reactivator such as pralidoxime chloride
The injection site is the mid-lateral thigh area; the autoinjector can inject through clothing; however, make sure pockets at the injection site are empty; people who may not have a lot of fat at injection site should also be injected in mid-lateral outer thigh; before giving the injection, bunch up the thigh to provide a thicker area for injection.
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Formulary
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