atropine IV/IM (Rx)

Brand and Other Names:AtroPen
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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

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
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Interactions

Interaction Checker

and atropine IV/IM

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            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.

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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

              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
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              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.

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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, 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

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              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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              Images

              No images available for this drug.
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              Patient Handout

              A Patient Handout is not currently available for this monograph.
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              Formulary

              FormularyPatient Discounts

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              To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.

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              • View the formulary and any restrictions for each plan.
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              • Compare formulary status to other drugs in the same class.
              • Access your plan list on any device – mobile or desktop.

              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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              Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.