- the treatment of sinus bradycardia, particularly when related to parasympathetic influences (digoxin, beta blocking agents, hyperactive carotid sinus reflex). Persistent bradycardia usually represents persistent hypoxia
- also used during cardiopulmonary resuscitation
- atropine is a naturally occurring antimuscarinic drug
- antimuscarinic drugs competitively inhibit the action of acetylcholine on muscarinic receptors (including smooth and cardiac muscle, exocrine glands and postganglionic cholinergic nerve terminals)
- atropine can initially cause bradycardia, an effect which is usually transient and mild; the heart rate then returns to normal, or increases, depending on the dose and the vagal input into the heart rate at the time
- the time to peak tachycardia is 12 to 16 minutes; the duration of action is 6h
- can cause cardiac arrhythmias, especially during the first 2 minutes after IV administration; this tends to occur more with low, rather than large, doses
- low doses: dilated pupils, dry mucous membranes, flushed skin with rash, fever, hyperthermia
- higher doses: tachycardia, abdominal distention with absent bowel activity, urinary retention, sedation followed by excitation, cardiac arrhythmias
- atropine is INCOMPATIBLE with many other drugs (eg. sodium bicarbonate); therefore, DO NOT mix atropine with other drugs
- myocardial oxygen consumption and ischemia may be increased by atropine-induced tachycardia and may aggravate heart failure
- rapid IV administration of atropine may cause ventricular tachycardia and
- For prolonged cardiopulmonary resuscitation and bradycardia:
- 0.01 to 0.03 mg/kg (10 to 30 mcg/kg) by IV push, over 1 minute, given by a physician; may repeat every 2-10 minutes, suggested maximum total dose of 0.04 mg/kg (40 mcg/kg)
- may also administer via endotracheal tube, suggested dose is 2 to 3 times IV dose
- For Elective Intubation:
- 0.02 mg/kg (20 mcg/kg) by IV push, over 1 minute, given by an MD/CNS
DIRECTIONS FOR DILUTION
- the 0.4 mg/mL (400 mcg/mL) ampoule can be diluted to 25 mcg/mL to facilitate administration of the drug
- Inject 1 mL of 400 mcg/mL into a 20 mL syringe
- Add 15 mL sterile water for injection to the 20 mL syringe
|... Concentration||=||400 mcg/16mL|
| ||=||25 mcg/mL|
- 0.4 mg/mL (400 mcg/mL), ampoule
- McEvoy G K (ed): AHFS Drug Information, American Society of Hospital Pharmacists, 1991.
- Roberts, RJ: Drug Therapy in Infants, W.B. Saunders, Toronto, 1984.
- Gomella TL (Ed): Neonatology - Management, Procedures, On-Call Problems, Diseases, Drugs, 1992, Appleton and Lange, Norwalk, Connecticut.
- Young TE and Mangum OB: Neofax - A Manual of Drugs Used in Neonatal Care, Columbus, Ohio: Ross Laboratories, 1992.