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Drug dosage identifier

Atropine sulphate

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Dose and administration

  1. 10-30 micrograms/kg/dose IV over 1 minute, IM or ETT (ETT route to be used only if IV route not possible).
  2. Dose may be repeated every 10-15 minutes to achieve desired effect, with a maximum total dose of 40 micrograms/kg.

Indications

  1. Severe sinus bradycardia, particularly when parasympathetic influences on the heart (digoxin, beta blocker drugs, hyperactive carotid sinus reflex) predominate.
  2. To reduce the muscarinic effects of neostigmine when reversing neuromuscular blockade.
  3. Prevention of reflex bradycardia during intubation.

Contraindications and precautions

  1. Known hypersensitivity to atropine.
  2. Abdominal distension with decreased peristalsis and/or intestinal obstruction.
  3. Gastroesophageal reflux.
  4. Obstructive uropathy.
  5. Congenital glaucoma.
  6. Caution in patients with Down Syndrome.

Clinical pharmacology

Atropine, a naturally occurring alkaloid, is an anticholinergic agent. Acts by competitive inhibition of the actions of acetylcholine on muscarinic receptors. Increases heart rate by decreasing the effects of the parasympathetic system while increasing the effects of the sympathetic system. Vagal influences on the gastrointestinal tract are partially inhibited by atropine. Motor activity in the stomach and small and large intestines is reduced. Oesophageal sphincter tone is reduced. Salivary secretion is inhibited. Atropine relaxes bronchial and bronchiolar smooth muscle, thereby reducing airway resistance and increasing dead space by 30%.

Rapid absorption from intestinal tract but not the stomach. Pharmacological activity of parenteral administration is 2-3 times greater than enteral administration. Low binding (20%) to human plasma protein. Excreted mainly unchanged via the urine.

Rapid onset of action. Peak effects: cardiovascular (12-16 minutes), gastrointestinal tract (1-2 hours). Duration of action 4-6 hours.

Possible adverse effects

  1. Tachycardia
  2. Urinary retention
  3. Impaired gastrointestinal motility
  4. Hyperthermia
  5. Hot, dry scarlet flushed skin
  6. Cardiac arrhythmias
  7. Dry mucous membranes, dry mouth

Special considerations

  1. Limited use in newborn infants. Should not be used in neonatal resuscitation.
  2. Management of atropine toxicity: stop atropine, treat anticholinergic symptoms with physostigmine 0.5 mg by slow IV infusion.
  3. Sodium chloride content 9mg.

Management of Atropine administration

Description

Clear, colourless solution 600 micrograms/ml in 1 ml polyamps. pH 3 - 6.5.

Prescription

Charted on stat page of prescription chart in micrograms/dose.

Administration

Slow IV Injection

  1. Is administered by the doctor / NS-ANP. In an emergency situation the nurse may administer under the direct supervision of the doctor present.
  2. Further dilution not necessary.
  3. Administer IV by slow injection over 1 minute.
  4. Filter prior to administration through a Pall 0.2 micron filter.
  5. Compatible with D5W and NS.
  6. Do NOT mix with other drugs, IV solutions, blood and blood products.
  7. Flush line with NS before and after administration of atropine.

IM Injection

Further dilution not necessary.

Administration of Intratracheal Atropine

  1. Administered by Doctor/NS-ANP or Nurse with neonatal IV drug certification.
  2. Instil into endotracheal tube followed immediately by 1ml NS.

Nursing considerations

  1. Observe IV site for signs of extravasation.
  2. Assess for signs of adverse effects.
  3. Continuous cardiorespiratory monitoring.
  4. Document vital signs hourly and PRN.
  5. Monitor fluid balance.
  6. Ensure good oral care.
  7. Monitor temperature closely for hyperthermia.
  8. Observe for gastric distension.

Storage

  • Store at room temperature <30° C.
  • Discard ampoule after opening.

References

  1. Roberts RJ. Drug therapy in infants: Pharmacologic principles and clinical experience. Philadelphia, WB Saunders, 1984 p284-7. 
  2. Adams RG, Verma P, Jackson M, Miller RL. Plasma pharmacokinetics of intravenously administered atropine in normal human subjects. J Clin Pharmacol 1982; 22:477. 
  3. Kattwinkel J, Fanaroff AA, Klaus M. Bradycardia in preterm infants: Indications and hazards of atropine therapy. Pediatrics 1976; 58:494. 
  4. Young TE, Mangum OB, Neofax. A manual of drugs used in neonatal care. 11th Edition 1998, p102-3. 

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Document Control

  • Date last published: 26 August 1998
  • Document type: Drug Dosage Guideline
  • Services responsible: ADHB Pharmacy, Neonatology
  • Editor: Sarah Bellhouse
  • Review frequency: 2 years