ATROPINE SULFATE

Posology As a pre-medication Adults: 300-600 micrograms IM or SC about 30-60 minutes before induction of anaesthesia or 300-600 micrograms IV immediately before induction.

Paediatric population:

Paediatric age group by IV injection immediately before induction of anaesthesia by SC or IM injection 30- 60 minutes before induction of anaesthesia Neonate 10 micrograms/kg body weight 10 micrograms/kg body weight Child (1 month to 11 years) 20 micrograms/kg body weight (maximum 600 micrograms) 10-30 micrograms/kg (maximum 600 micrograms) Child (12 years to 17 years) the adult dose the adult dose As an antidote to cholinesterase inhibitors The UK National Poisons Information Service (NPIS) should be consulted for further specific advice.

As an antidote to organophosphate pesticides and in muscarinic mushroom poisoning The UK National Poisons Information Service (NPIS) should be consulted for further specific advice. Adults: 2mg IV every 5 minutes until muscarinic effects disappear or signs of atropine toxicity are seen.

In severe poisoning, some sources have suggested doubling the dose of atropine every 5 to 10 minutes until improvement is seen. Continuous infusion has also been used. Paediatric population (from 1 month to 17 years): 20 micrograms/kg body weight IV (maximum per dose 2 mg) given every 5- 10 minutes until the skin becomes flushed and dry, the pupils dilate, and bradycardia is abolished.

The frequency of administration depends on the severity of poisoning. Treatment of symptomatic sinus bradycardia induced by pilocarpine The UK National Poisons Information Service (NPIS) should be consulted for further specific advice.

2 mg given IV in conjunction with neostigmine methylsulfate.

Paediatric population:

Neonate 20 micrograms/kg body weight given IV in conjunction with neostigmine methylsulfate. Child (1 month to 11 years) 20 micrograms/kg body weight (max. 2 mg) given IV in conjunction with neostigmine methylsulfate. Child (12 years to 17 years) The adult dose should be given.

g. shock, myocardial ischemia, severe heart failure, syncope) Adults: 500 micrograms by IV injection every 3-5 minutes, maximum 3 mg per course. g. after insertion of nasogastric tube) if no response to oxygenation Paediatric population: Neonate and child (1 month to 11 years) 20 micrograms/kg body weight IV.

The most commonly reported adverse events are due to the action of atropine on muscarinic and, at high doses, nicotinic receptors. These effects are dose-related and usually reversible when therapy is discontinued. 4 Special warnings and precautions for use).

Reporting of suspected adverse reactions Reporting suspected adverse reactions after authorisation of the medicinal product is important. It allows continued monitoring of the benefit/risk balance of the medicinal product. Healthcare professionals are asked to report any suspected adverse reactions via the Yellow Card Scheme at: System Organ Class (SOC) Undesirable effects Immune system disorders Anaphylaxis Psychiatric disorders Confusional states, especially in the elderly.

At higher doses hallucinations, restlessness, delirium. Nervous system disorders Dizziness Eye disorders Dilatation of the pupils with loss of accommodation and photophobia, raised intraocular pressure. 4). Gastrointestinal disorders Dry mouth with difficulty in swallowing, nausea, vomiting, constipation.

Inhibition of gastric secretion, retrosternal pain due to gastric reflux. Skin and subcutaneous tissue disorders Dry skin, urticaria, rashes, skin exfoliation. Renal and urinary disorders Difficulty with micturition General disorders and administration site conditions Thirst, fever.

uk/yellowcard or search for MHRA Yellow Card in the Google Play or Apple App Store.

Atropine sulfate should be used with caution in children, the elderly and those with Down’s syndrome who may be more susceptible to its adverse effects. It should be given with caution to patients with diarrhoea, urinary retention. Due to the risk of hyperthermia it should not be given to patients, especially children, when the ambient temperature is high.

It should be used with caution in patients with fever. Care is required in patients with acute myocardial infarction as ischaemia and infarction may be exacerbated and in patients with hypertension. Caution is also required when using the drug in patients with conditions characterised by tachycardia such as thyrotoxicosis, tachyarrhythmias, heart failure, coronary heart disease and during cardiac surgery.

Paradoxical atrioventricular block or sinus arrest has been reported following administration of atropine in a few patients after heart transplantation. The use of atropine for therapeutic or diagnostic procedures in heart transplant patients should be undertaken with extreme caution, and ECG monitoring and equipment for immediate temporary pacing should be available.

Caution is required when atropine is administered systemically to patients with chronic obstructive pulmonary disease, as a reduction in bronchial secretions may lead to the formation of mucous plugs. Antimuscarinics such as atropine may delay gastric emptying, decrease gastric motility and relax the oesophageal sphincter.

g. reflux oesophagitis. Caution is advised for patients with renal or hepatic insufficiency.

1. • Angle-closure glaucoma or narrow angle glaucoma, • Prostatic enlargement as may lead to urinary retention, • Significant bladder outflow obstruction, • Myasthenia gravis (unless given in conjunction with anticholinesterase), • Paralytic ileus, • Pyloric stenosis, • Gastro-intestinal obstruction, intestinal atony, • Severe ulcerative colitis, • Toxic megacolon.