Drug Therapy Protocols: Atropine

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Date April, 2018

Purpose To ensure a consistent procedural approach to Atropine administration.
Scope Applies to all QAS clinical staff.
Author Clinical Quality & Patient Safety Unit, QAS
Review date April, 2021
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 Atropine
April, 2018

Drug class
Precautions
Antichlolinergic (antimuscarinic)
Atrial flutter

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•
Pharmacology
• Atrial fibrillation
Atropine works by inhibiting the action of the parasympathetic 

• AMI
nervous system allowing for an unchallenged sympathetic response.
• Glaucoma
It successfully blocks the action of the vagus nerve on the heart, 

increases the rate of the SA node, conduction through the AV node 

and blocks exocrine gland activity.[1-3]
Side effects
Metabolism
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Atropine is metabolised by the liver and excreted mainly by
the kidneys.[1-3]
• Agitation
• Hallucinations
• Dilated pupils
• Dry mouth/dry skin/reduced bronchial and
Indications gastric secretions
• Tachycardia
• Bradycardia (with poor perfusion)[4]

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• Envenomation (with increased parasympathetic
activity)
• Hypersalivation (secondary to ketamine
Presentation

administration)
• Ampoule, 1.2 mg/1 mL atropine
• Organophosphate toxicity (with cardiac AND/OR
respiratory compromise)[5]

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Contraindications
Onset (IV)

1–2 minutes
Duration (IV)

Up to 5 hours
Half-life

3–4 hours
(peak 15–50 minutes)
• Allergy and/or Adverse Drug Reaction

Figure 4.4

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 Atropine
April, 2018

Schedule
Special notes (cont.)
• S4 (Restricted drugs).

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Routes of administration
• Atropine requirements for organophosphate toxicity vary
enormously between patients and organophosphates.
• Target atropinisation for organophosphate toxicity is 


ECP
CCP
Intramuscular injection (IM) achieved when the patient has the following endpoints:
- chest clear and no wheeze on auscultation
- heart rate > 80 beats per minute

ECP
CCP
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Intravenous injection (IV)
- systolic BP > 80 mmHg
• Organophosphate toxicity induced tachycardia should not

CCP
Intraosseous injection (IO) prohibit atropine administration if respiratory distress is
present (e.g. profuse oral and/or bronchial secretions).
• Total loading dose (CCP ESoP – aeromedical IV INF protocol) 

Intravenous infusion (IV INF) E CCP is defined as the sum of the initial doses given at the 


UNCONTROLLED WHEN PRINTED beginning of a course of treatment prior to administering 


a lower maintenance dose.
• Atropine administration is not indicated in the newly born

Special notes pre-hospital resuscitation.
• All cannulae and IV lines must be flushed thoroughly 

• A dose of up to 1.2 mg of atropine is generally sufficient to with sodium chloride 0.9% following each medication
resolve bradycardia in adult patients. Subsequent doses 
 administration.

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in patients who fail to respond is not usually beneficial.[1]
• Sub-therapeutic doses of atropine may cause paradoxical
bradycardia.

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 Atropine
April, 2018

Adult dosages Adult dosages (cont.)

Bradycardia (with poor perfusion) Organophosphate toxicity 


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IV 600 microg (with cardiac AND/OR respiratory compromise)
CCP

Repeated once after 2 minutes.

Total maximum dose 1.2 mg. IM ECP officers require QAS Clinical Consultation

ECP
CCP
and Advice Line approval in all situations.
IO 600 microg
CCP

1.2 mg
Repeated once after 2 minutes.
Total maximum dose 1.2 mg. Repeated at 5 minute intervals.
No maximum dose.

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Envenomation (with increased parasympathetic activity)
IV ECP officers require QAS Clinical Consultation

ECP
CCP
IM ECP officers require QAS Clinical Consultation and Advice Line approval in all situations.
ECP
CCP

and Advice Line approval in all situations. 1.2 mg

1.2 mg Repeated at 5 minute intervals.
Repeated at 5 minute intervals. No maximum dose.
No maximum dose.
IO 1.2 mg

CCP
IV Repeated every 5 minutes.

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ECP officers require QAS Clinical Consultation
ECP
CCP

and Advice Line approval in all situations. No maximum dose.

1.2 mg
IV RSQ Clinical Coordinator consultation and

E CCP
Repeated at 5 minute intervals.
No maximum dose.
INF approval required in all situations.
5–10 mL/hour (10–20% of leading dose/hour) 

IO 1.2 mg to maintain atropinisation.
CCP

Repeated at 5 minute intervals. Syringe preparation: Mix the total loading dose 

No maximum dose. of atropine with sodium chloride 0.9% to make

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Hypersalivation (secondary to ketamine administration)
IV 600 microg
up a total volume of 50 mL. Ensure all syringes
are appropriately labelled.
CCP

Single dose only.

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 Atropine
April, 2018

Paediatric dosages Paediatric dosages (cont.)

Bradycardia (with poor perfusion) Hypersalivation (secondary to ketamine administration)

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IV 20 microg/kg IV 20 microg/kg
CCP

CCP
Single dose not to exceed 600 microg. Single dose not to exceed 600 mcg.
Repeated once after 2 minutes. Single dose only.
Total maximum dose 40 microg/kg.

IO 20 microg/kg
CCP

Single dose not to exceed 600 microg.

Repeated once after 2 minutes.

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Total maximum dose 40 microg/kg.

• Envenomation (with increased parasympathetic activity)

• Organophosphate toxicity (with cardiac AND/OR 

respiratory compromise)

IM ECP officers require QAS Clinical Consultation

ECP
CCP

and Advice Line approval in all situations.

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20 microg/kg
Single dose not to exceed 600 mcg.
Repeated at 5 minute intervals.
No maximum dose.

IV ECP officers require QAS Clinical Consultation

ECP
CCP

and Advice Line approval in all situations.

20 microg/kg
Single dose not to exceed 600 mcg.

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IO
Repeated at 5 minute intervals.
No maximum dose.
20 microg/kg
CCP

Single dose not to exceed 600 mcg.

Repeated at 5 minute intervals.
No maximum dose.
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