NAME OF DRUG
atropine sulphate

CLASSIFICATION

Anticholinergic

ALTERNATE NAME

INDICATIONS

• for relaxation of gastrointestinal, biliary and genitourinary tracts
• suppression of salivary, gastric and respiratory secretions
• sinus bradycardia and atrioventricular block, asystole
• antidote for organophosphate and other anticholinesterase poisoning

RECONSTITUTION AND STABILITY

• stable at room temperature

COMPATIBILITY

• compatible with D5W, NS, LR
• compatible via Y site with amrinone, dobutamine, furosemide, heparin, hydrocortisone, lorazepam, midazolam, potassium chloride, verapamil, vitamin B complex with C
• incompatible with norepinephrine, sodium bicarbonate
• see Appendix X for compatibilities in the same syringe

ROUTES OF ADMINISTRATION

• SC
• IM
• IV direct - rapidly over a few seconds
• IV intermittent, IV infusion - NOT RECOMMENDED

VH & HSC ADMINISTRATION POLICY

B - Direct IV route restricted to nurses in Special and Critical Care areas and the Telemetry unit. On general nursing units the direct IV route must be administered by a physician.

F - May be administered by direct IV by nurses in the Palliative Care Unit provided venipuncture has been established, and according to policies and recommendations stated in this manual.

DOSAGE

Preoperative: 0.4 mg administered 30-60 minutes prior to anesthesia

Antispasmodic: 0.3-1.2 mg every 4 - 6 hours

Asystole: 1 mg IV, may be repeated every 3-5 minutes if asystole persists

Bradycardia:

• Adults: 0.5-1.0 mg IV, may repeat every 3-5 minutes to a total dose of 0.04 mg/kg
      Minimum dose: 0.5 mg
• Children: 0.01-0.02 mg/kg IV, may repeat every 2-5 minutes for up to 3 doses
      Minimum dose: 0.1 mg
      Maximum total dose: 1 mg

Organophosphate poisoning:

• Adults:  1-2 mg IV initially; repeat with 1-5 mg every 20-30 minutes as necessary until cessation of secretions and pulse does not exceed 140 beats/minute
• Children:  0.05 mg/kg IV every 2-5 minutes until an atropine effect is noted; repeat doses every 1-4 hours as necessary

POTENTIAL HAZARDS OF PARENTERAL ADMINISTRATION

• tachycardia, temporary sensation of lightheadedness
• local irritation

IMPORTANT IMPLICATIONS

• anticholinergic side effects may occur
• paradoxical slowing of the heart rate occurs with low doses and/or slow infusion rates
• pulse rate should be monitored
• contraindicated in the presence of tachycardia secondary to cardiac insufficiency or thyrotoxicosis, acute hemorrhage with unstable cardiovascular status, acute angle-closure glaucoma
• use with caution in severe heart disease, hypertension, hyperthyroidism, autonomic neuropathy

Rev. Sept 1997