Atropine
General
- Type: Anticholinergic
- Routes of Administration: IV/IM/IO/SC, endotracheal, nebulized, PO, topical/ophthalmic
- Common Trade Names: Atropine, Atreza, SalTropine, AtroPen, IsoptoAtropine
Adult Dosing
Symptomatic bradyarrhythmia or AV block
- 0.5 mg IV rapid push q3-5m (max = 0.04 milligram/kg)
Cardiac arrest (bradyasystolic)
- 1mg IV/IM/subQ/endotracheally q3-5m
Organophosphate toxicity
- 1-3mg IV/IM/SC/endotracheally q10-30m, max 3 doses
IBS, PUD
- 0.4-0.6 mg PO or IV/IM/SC q4-6h
Cycloplegia/mydriasis induction
- 1-2 drops of 1% solution 1-3 times daily
Pediatric dosing
Symptomatic bradyarrhythmia or AV block
- 0.01-0.03 mg/kg IV/IO q1-2h
Cardiac arrest (bradyasystolic)
- 0.01-0.03 mg/kg IV/IM/subQ/endotracheally
Organophosphate toxicity
- 0.01-0.03 mg/kg IV/IM/subQ/endotracheally
IBS, PUD
- 0.01 mg/kg (max 0.4 mg or 0.3 mg/m2) PO/SC q4-6h
Cycloplegia/mydriasis induction
- 1-2 drops of 1% solution 1-3 times daily
Special Populations
- Pregnancy Rating: C
- Lactation: Infant risk cannot be ruled out
- Renal Dosing: no adjustment
- Hepatic Dosing: no adjustment
- Ineffective in cardiac transplant patients
Contraindications
- Allergy to class/drug
- Primary glaucoma or predisposition to narrow anterior chamber angle glaucoma
Adverse Reactions
Serious
- Cardiac dysrhythmia, tachyarrhythmia
- If given slowly or in amounts <0.5mg, may cause paradoxical bradycardia
- Increased O2 consumption
- Hypotension
- Coma
- Respiratory depression
- Glaucoma
Common
- Constipation, xerostomia
- Blurred vision, decreased lacrimation, eye pain, photophobia, superficial keratitis
Pharmacology
- Half-life: 2.5 hrs
- Metabolism: hepatic
- Excretion: renal
- Onset of action (IV) = 2-4min
- Duration of action (IV) = 5hr
Mechanism of Action
- Parasympatholytic
- Increases sinus/AV conduction
Indications by Condition
The following table is automatically generated from disease/condition pages across WikEM.
| Indication | Dose | Context | Route | Population | |
|---|---|---|---|---|---|
| Beta-blocker toxicity#Atropine Symptomatic bradycardia (initial) Adult | Beta-blocker toxicity | 0.5-1 mg IV q3-5min (max 3 mg) | Symptomatic bradycardia (initial) | IV | Adult |
| Calcium channel blocker toxicity#Atropine Symptomatic bradycardia Adult | Calcium channel blocker toxicity | 0.5-1 mg IV q2-3min (max 3 mg) | Symptomatic bradycardia | IV | Adult |
| Calcium channel blocker toxicity#Atropine Symptomatic bradycardia (pediatric) Pediatric | Calcium channel blocker toxicity | 0.02 mg/kg IV (min 0.1 mg) | Symptomatic bradycardia (pediatric) | IV | Pediatric |
| Carbamate poisoning#Atropine Antimuscarinic, first-line Pediatric | Carbamate poisoning | 0.02-0.05mg/kg IV (min 0.1mg), double q5min until drying of secretions | Antimuscarinic, first-line | IV | Pediatric |
| Carbamate poisoning#Atropine Antimuscarinic, first-line Adult | Carbamate poisoning | 1-2mg IV, double dose q5min until drying of secretions | Antimuscarinic, first-line | IV | Adult |
| Carbamate toxicity#Atropine Cholinergic toxicity antidote (muscarinic) Pediatric | Carbamate toxicity | 0.02-0.05 mg/kg IV (min 0.1 mg), double q5min | Cholinergic toxicity antidote (muscarinic) | IV | Pediatric |
| Carbamate toxicity#Atropine Cholinergic toxicity antidote (muscarinic) Adult | Carbamate toxicity | 1-2 mg IV (double q5min until atropinization) | Cholinergic toxicity antidote (muscarinic) | IV | Adult |
| Cholinergic crisis#Atropine Antimuscarinic, first-line Adult | Cholinergic crisis | 2-4mg IV q5min, titrate to resolution of bronchorrhea; then infusion at 10% of loading dose/hr | Antimuscarinic, first-line | IV | Adult |
| Clonidine toxicity#Atropine Bradycardia Adult | Clonidine toxicity | 0.5-1 mg | Bradycardia | IV | Adult |
| Electronic cigarettes#Atropine Cholinergic toxicity antidote (muscarinic) Adult | Electronic cigarettes | 1-2 mg IV (double q5min until atropinization) | Cholinergic toxicity antidote (muscarinic) | IV | Adult |
| Electronic cigarettes#Atropine Cholinergic toxicity antidote (muscarinic) Pediatric | Electronic cigarettes | 0.02-0.05 mg/kg IV (min 0.1 mg), double q5min | Cholinergic toxicity antidote (muscarinic) | IV | Pediatric |
| Mushroom toxicity#Atropine Severe cholinergic symptoms (muscarinic mushrooms) Adult | Mushroom toxicity | 0.5-1mg IV (adult); 0.01mg/kg IV (peds) | Severe cholinergic symptoms (muscarinic mushrooms) | IV | Adult |
| Nicotine toxicity#Atropine Cholinergic toxicity antidote (muscarinic) Adult | Nicotine toxicity | 1-2 mg IV (double q5min until atropinization) | Cholinergic toxicity antidote (muscarinic) | IV | Adult |
| Nicotine toxicity#Atropine Cholinergic toxicity antidote (muscarinic) Pediatric | Nicotine toxicity | 0.02-0.05 mg/kg IV (min 0.1 mg), double q5min | Cholinergic toxicity antidote (muscarinic) | IV | Pediatric |
| Organophosphate toxicity#Atropine 1st line antidote (muscarinic antagonist) Pediatric | Organophosphate toxicity | 0.02-0.05 mg/kg (min 0.1 mg) | 1st line antidote (muscarinic antagonist) | IV | Pediatric |
| Organophosphate toxicity#Atropine 1st line antidote (muscarinic antagonist) Adult | Organophosphate toxicity | 1-2 mg IV, then double q5min as needed | 1st line antidote (muscarinic antagonist) | IV | Adult |
| Organophosphate toxicity#Atropine Cholinergic toxicity antidote (muscarinic) Adult | Organophosphate toxicity | 1-2 mg IV (double q5min until atropinization) | Cholinergic toxicity antidote (muscarinic) | IV | Adult |
| Organophosphate toxicity#Atropine Cholinergic toxicity antidote (muscarinic) Pediatric | Organophosphate toxicity | 0.02-0.05 mg/kg IV (min 0.1 mg), double q5min | Cholinergic toxicity antidote (muscarinic) | IV | Pediatric |
| Rapid sequence intubation#Atropine Premedication Pediatric | Rapid sequence intubation | 0.02 mg/kg, no minimum dose | Premedication | IV | Pediatric |
| Xylazine#Atropine Symptomatic bradycardia Adult | Xylazine | 0.5-1mg IV, may repeat q3-5min (max 3mg) | Symptomatic bradycardia | IV | Adult |