Formulary
Atropine sulfate: Indications, Dosing, Side Effects and Interactions
Atropine sulfate clinical drug profile including indications, dosing, side effects, cautions and interactions.
MedNext Academy | 6 min read
Atropine sulfate: Indications, Dosing, Side Effects and Interactions
Atropine sulfate clinical drug profile including indications, dosing, side effects, cautions and interactions.
Indications and dose
**Cycloplegia**
- **Adult** (To The Eye Using Eye Drop): (consult product literature).
**Anterior uveitis**
- **Adult** (To The Eye Using Eye Drop): (consult product literature).
**Symptomatic bradycardia due to acute overdosage of beta-blockers**
- **Child** (By Intravenous Injection): 0.02 mg/kg (max. per dose 1.2 mg), repeat doses may be necessary.
- **Adult** (By Intravenous Injection): 0.5-1.2 mg, repeat doses may be necessary.
**Treatment of poisoning by organophosphorus insecticide or nerve agent (in combination with pralidoxime chloride)**
- **Child** (By Intravenous Injection): 20 micrograms/kg every 5-10 minutes (max. per dose 2 mg) until the skin becomes flushed and dry, the pupils dilate, and bradycardia is abolished, frequency of administration dependent on the severity of poisoning.
- **Adult** (By Intravenous Injection): 2 mg every 5-10 minutes until the skin becomes flushed and dry, the pupils dilate, and bradycardia is abolished, frequency of administration dependent on the severity of poisoning.
**Symptomatic relief of gastro-intestinal disorders characterised by smooth muscle spasm**
- **Adult** (By Mouth): 0.6-1.2 mg daily, dose to be taken at night.
**Premedication**
- **Child** (By Intravenous Injection): 12-17 years 300-600 micrograms, to be administered immediately before induction of anaesthesia.
- **Adult** (By Intravenous Injection): 300-600 micrograms, to be administered immediately before induction of anaesthesia.
- **Child** (By Subcutaneous Injection, Or By Intramuscular Injection): 12-17 years 300-600 micrograms, to be administered 30-60 minutes before induction of anaesthesia.
- **Adult** (By Subcutaneous Injection, Or By Intramuscular Injection): 300-600 micrograms, to be administered 30-60 minutes before induction of anaesthesia.
**Intra-operative bradycardia**
- **Child** (By Intravenous Injection): 12-17 years 300-600 micrograms, larger doses may be used in emergencies.
- **Adult** (By Intravenous Injection): 300-600 micrograms, larger doses may be used in emergencies.
**Control of muscarinic side-effects of neostigmine in reversal of competitive neuromuscular block**
- **Child** (By Intravenous Injection): 12-17 years 0.6-1.2 mg.
- **Adult** (By Intravenous Injection): 0.6-1.2 mg.
**Excessive bradycardia associated with beta-blocker use**
- **Adult** (By Intravenous Injection): 0.6-2.4 mg in divided doses (max. per dose 600 micrograms).
**Bradycardia following myocardial infarction (particularly if complicated by hypotension)**
- **Adult** (By Intravenous Injection): 500 micrograms every 3-5 minutes; maximum 3 mg per course.
**Cycloplegia for atropine sulfate**
- **Child 3 months-17 years** (To the eye using eye drop): Apply twice daily for 3 days, before procedure.
**Anterior uveitis for atropine sulfate**
- **Child 2-17 years** (To the eye using eye drop): Apply 1 drop up to 4 times a day.
**Symptomatic bradycardia due to acute overdosage of beta-blockers for atropine sulfate**
- **Child** (By intravenous injection): 0.02 mg/kg (max. per dose 1.2 mg), repeat doses may be necessary.
**Treatment of poisoning by organophosphorus insecticide or nerve agent (in combination with pralidoxime chloride) for atropine sulfate**
- **Child** (By intravenous injection): 20 micrograms/kg every 5-10 minutes (max. per dose 2 mg) until the skin becomes flushed and dry, the pupils dilate, and bradycardia is abolished, frequency of administration dependent on the severity of poisoning.
**Premedication for atropine sulfate**
- **Neonate** (By intravenous injection): 10 micrograms/kg, to be administered immediately before induction of anaesthesia.
- **Child 1 month-11 years** (By intravenous injection): 20 micrograms/kg, to be administered immediately before induction of anaesthesia (minimum 100 micrograms, max. 600 micrograms).
- **Child 12-17 years** (By intravenous injection): 300-600 micrograms, to be administered immediately before induction of anaesthesia.
- **Neonate** (By subcutaneous injection, or by intramuscular injection): 10 micrograms/kg, to be administered 30-60 minutes before induction of anaesthesia.
- **Child 1 month-11 years** (By subcutaneous injection, or by intramuscular injection): 10-30 micrograms/kg, to be administered 30-60 minutes before induction of anaesthesia (minimum 100 micrograms, max. 600 micrograms).
- **Child 12-17 years** (By subcutaneous injection, or by intramuscular injection): 300-600 micrograms, to be administered 30-60 minutes before induction of anaesthesia.
- **Neonate** (By mouth): 20-40 micrograms/kg, to be administered 1-2 hours before induction of anaesthesia.
- **Child** (By mouth): 20-40 micrograms/kg (max. per dose 900 micrograms), to be administered 1-2 hours before induction of anaesthesia.
**Intra-operative bradycardia for atropine sulfate**
- **Neonate** (By intravenous injection): 10-20 micrograms/kg.
- **Child 1 month-11 years** (By intravenous injection): 10-20 micrograms/kg.
- **Child 12-17 years** (By intravenous injection): 300-600 micrograms, larger doses may be used in emergencies.
**Control of muscarinic side-effects of neostigmine in reversal of competitive neuromuscular block for atropine sulfate**
- **Neonate** (By intravenous injection): 20 micrograms/kg.
- **Child 1 month-11 years** (By intravenous injection): 20 micrograms/kg (max. per dose 1.2 mg).
- **Child 12-17 years** (By intravenous injection): 0.6-1.2 mg.
Cautions
For all antimuscarinics (eye) Children under 3 months owing to the possible association between cycloplegia and the development of amblyopia; darkly pigmented iris is more resistant to pupillary dilatation and caution should be exercised to avoid overdosage; mydriasis can precipitate acute angle-closure glaucoma (usually in those aged over 60 years and hypermetropic (long-sighted), who are predisposed to the condition because of a shallow anterior chamber) (in adults); mydriasis can precipitate acute angle-closure glaucoma (usually in those who are predisposed to the condition because of a shallow anterior chamber) (in children) Cautions For all antimuscarinics (systemic) Acute myocardial infarction (in adults); arrhythmias (may be worsened); autonomic neuropathy; cardiac insufficiency (due to association with tachycardia); cardiac surgery (due to association with tachycardia); children (increased risk of side-effects) (in children); conditions characterised by tachycardia; congestive heart failure (may be worsened); coronary artery disease (may be worsened); diarrhoea; elderly (especially if frail) (in adults); gastro-oesophageal reflux disease; hiatus hernia with reflux oesophagitis; hypertension; hyperthyroidism (due to association with tachycardia); individuals susceptible to angle-closure glaucoma; prostatic hyperplasia (in adults); pyrexia; ulcerative colitis Cautions, further information Elderly In adults: Screening Tool of Older Persons' potentially inappropriate Prescriptions (STOPP) criteria to aid medication reviews (see Prescribing in the elderly for information). Potentially inappropriate: if treating extrapyramidal side-effects of antipsychotic medications (risk of antimuscarinic toxicity) with delirium or dementia (risk of exacerbation of cognitive impairment), angle-closure glaucoma (contra-indicated; risk of acute exacerbation of glaucoma), or chronic prostatism (risk of urinary retention) if two or more antimuscarinic drugs prescribed concomitantly (risk of increased antimuscarinic toxicity)
Contraindications
For all antimuscarinics (systemic) Angle-closure glaucoma; gastro-intestinal obstruction; intestinal atony; myasthenia gravis (but some antimuscarinics may be used to decrease muscarinic side-effects of anticholinesterases); paralytic ileus; pyloric stenosis; severe ulcerative colitis; significant bladder outflow obstruction; toxic megacolon; urinary retention
Side effects
Control of muscarinic side-effects of neostigmine in reversal of competitive neuromuscular block for atropine sulfate By intravenous injection Child 12-17 years 0.6-1.2 mg. Adult 0.6-1.2 mg.
Interactions
**Other interactions (1):**
- The effects of Atropine may be potentiated by the concomitant administration of other products with antimuscarinic properties, e.g.
Pregnancy
With systemic use: Not known to be harmful; manufacturer advises caution.
Breast feeding
With systemic use: May suppress lactation; small amount present in milk-manufacturer advises caution.
Medicinal forms
Solution,Solution,Drops
Clinical governance
**Author:** MedNext Clinical Team. **Clinical reviewer:** Dr Shameer Deen, MBBS, MS, MRCS. **Sources:** BNF, Indian Pharmacopoeia, CIMS India. **Correction:** Report errors at support@mednext.academy.
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