ATROPINE SULPHATE

Pre-oeprativemedication.

Adults:

By the intravenous route: 300 - 600 micrograms immediately before induction of anaesthesia. By the intramuscular or subcutaneous route: 300 - 600 micrograms, one hour before induction of anaesthesia.

Children:

By the subcutaneous route 30 minutes before induction of anaesthesia Premature infants: 65 micrograms; Children up to 3kg: 100 micrograms; children 7-9kg:: 200 micrograms; Children 12-16kg: 300 micrograms; Children 20-27kg: 400 micrograms; Children 32kg: 500 micrograms; Children 41kg: 600 micrograms; By the intramuscular route 30-60 minutes before induction of anaesthesia.

Alternative dosage statement for children over 1 year: 10-20 micrograms/kg 30-60 minutes before induction of anaesthesia.. As an antidote to cholinesterase inhibitors Adults: 2mg, preferably IV. Children: 50 micrograms/kg IV or IM. Repeat dose every 5-10 minutes until signs of atropinisation appear.

As an antidote to organophosphate pesticides and in mushroom poisoning Adults: 2mg IV or IM. Children: 50 micrograms/kg IV or IM Repeat dose every 10-30 minutes until muscarinic signs and symptoms subside. 2 mg given IV in conjunction with neostigmine methyl- sulfate.

In cardiopulmonary resuscitation Adults: 3mg IV once Children: 20 micrograms/kg IV once In arrhythmias Bradycardia, particularly if complicated by hypotension, 300 micrograms IV initially, increasing to 1mg if necessary.

Method of administration:

Atropine sulfate 1mg in 1ml solution for injection is administered by intravenous, intramuscular or subcutaneous injection.

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.

Immune system disorders:

Anaphylaxis.

Nervous system/ Psychiatric disorders:

Dizziness, confusional states, especially in the elderly. At higher doses hallucinations, restlessness, delirium.

Eye disorders:

Dilatation of the pupils with loss of accommodation and photophobia, raised intraocular pressure.

Cardiac disorders:

Transient bradycardia followed by tachycardia, palpitations, arrhythmias. 4).

Vascular disorders:

Flushing. 4).

Gastrointestinal disorders:

Dry mouth with difficulty in swallowing, nausea, vomiting, constipation. Inhibition of gastric secretion, retrosternal pain due to gastric reflux.

Skin & subcutaneous tissue disorders:

Dry skin, urticaria, rashes, skin exfoliation.

Renal & urinary disorders:

Difficulty with micturition.

General disorders:

Thirst, fever. 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.

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Atropine sulfate should be used with caution in children, the elderly and those with Down's syndrome. It should be given with caution to patients with diarrhoea, urinary retention or fever, and when the ambient temperature is high. Care is required in patients with acute myocardial infarction as ischaemia, and infarction may be exacerbated in patients with hypertension.

Caution is also required when using the drug in patients with conditions characterised by tachycardia such as thyrotoxicosis, cardiac insufficiency or failure 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 bronchial plugs.

Antimuscarinics such as atropine may delay gastric emptying, decrease gastric motility and relax the oesophageal sphincter. g. reflux oesophagitis.

1. Known hypersensitivity to the drug, closed-angle glaucoma, prostatic enlargement, myasthenia gravis (unless given in conjunction with anticholinesterase), paralytic ileus or pyloric stenosis and severe ulcerative colitis.