Page 105 - 2026 SMOG

ATROPINE SULFATE (ATROPEN)
Class/Mechanism of Action
• Anticholinergic, Antidysrhythmic, Antidote for Carbamate Anticholinesterase Poisoning
• Blocks acetylcholine at parasympathetic sites in smooth muscle, secretory glands, and the CNS;
increases cardiac output and dries secretions. Atropine reverses the muscarinic effects of cholinergic
poisoning. Reverses bronchorrhea and bronchoconstriction but does not affect the nicotinic receptors
responsible for muscle weakness, fasciculations, and paralysis.
Indications
• Labeled Indications
˚ Treatment of symptomatic sinus bradycardia, AV block (nodal level)
˚ Antidote for anticholinesterase poisoning (carbamate insecticides, nerve agents, organophosphates)
insecticides)
Contraindications
• Hypersensitivity to atropine or any component of the formulation
• Narrowangle glaucoma; adhesions between the iris and lens (ophthalmic product)
• Pyloric stenosis
• Prostatic hypertrophy
• NOTE: NO contraindication should prevent the use of atropine in the setting of life-threatening
organophosphate, carbamate, or nerve agent poisoning
Adverse Reactions/Precautions
• Tachycardia and arrhythmia (VTach, Vfib), hypotension, palpitations
• Dilated pupils
• Headache, dry mouth, constipation, urinary retention, flushing
• Higher doses may be required for organophosphate poisoning
• Paradoxical bradycardia noted with doses less than 0.1mg
• Pregnancy: Use with caution; do not withhold antidotes or cardiac medications due to pregnancy
• Lactation: Use with caution; present in breast milk
Dose/Administration
PEDIATRIC
ADULT
(Always reference Broselow Tape)
Symptomatic Bradycardia Symptomatic Bradycardia
• IV/IO • IV/IO
˚ 1mg q3–5min, not to exceed a total of 3mg ˚ 0.02mg/kg. May repeat once in 3–5min
Minimum SINGLE dose: 0.1mg
or 0.04mg/kg
■
Nerve Agent ■ Max SINGLE dose: 0.5mg
Poisoning/Organophosphate/Carbamate ■ Max TOTAL dose: 1mg in children;
Insecticide 3mg in adolescents
• IV/IO (Nerve Agent) Organophosphate/Carbamate Insecticide
˚ Atropine 20mg in 250mL, titrate to dry • IV/IO
respiratory secretions
Children <12 years: Initial dose:
• IM (ATNAA) ˚ 0.05mg/kg; repeat q5min prn, doubling the
˚ 2mg Atropine/600mg 2-Pam previous dose, until symptoms resolve
Severe symptoms: 3 doses (6mg total)
Children ≥12 years: Initial dose: 1mg/kg;
■
• IM (AtroPen) ˚ repeat q5min prn, doubling the previous
˚ 2mg once an exposure is known or strongly dose, until symptoms resolve
suspected
2026 Standard Medical Operating Guidelines (SMOG) • 97