Atropine Sulfate 0.4mg/ml Inj 1ml
It is used to treat some poisonings.In surgery, it is used to lower secretions such as saliva.It is used to treat muscle spasms of the GI (gastrointestinal) tract, gallbladder system, or urinary system.It is used when the heart is not beating.
Drug Class
Anticholinergic; Antidote; Antispasmodic
Pharmacologic Class
Muscarinic receptor antagonist
Pregnancy Category
Category C
FDA Approved
Jan 1970
DEA Schedule
Not Controlled
Overview
What is this medicine?
Atropine is a medication given by injection, often in emergency situations. It works by blocking certain signals in the body to speed up a slow heart rate, reduce body fluids like saliva, or act as an antidote for certain types of poisoning.
How to Use This Medicine
Taking Your Medication
To use this medication correctly, follow your doctor's instructions and read all the information provided to you. It is essential to follow the instructions carefully. This medication is administered via injection, which can be given into a muscle, under the skin, or into a vein.
Storing and Disposing of Your Medication
If you need to store this medication at home, consult with your doctor, nurse, or pharmacist to determine the proper storage procedure.
Missing a Dose
If you miss a dose, contact your doctor to receive guidance on what to do next.
To use this medication correctly, follow your doctor's instructions and read all the information provided to you. It is essential to follow the instructions carefully. This medication is administered via injection, which can be given into a muscle, under the skin, or into a vein.
Storing and Disposing of Your Medication
If you need to store this medication at home, consult with your doctor, nurse, or pharmacist to determine the proper storage procedure.
Missing a Dose
If you miss a dose, contact your doctor to receive guidance on what to do next.
Lifestyle & Tips
- Not applicable for acute, injectable use.
Available Forms & Alternatives
Available Strengths:
- Atropine Sulf 1% Ophth Ointment
- Atropine Sul 0.4mg/ml Inj, 1ml
- Atropine Sulfate 1mg/ml Inj, 1ml
- Atropine Sulfate 0.1mg/ml Inj, 10ml
- Atropine Sulf 1% Oph Soln 2ml
- Atropine Sulf 1% Oph Soln 5ml
- Atropine Sulf 1% Oph Soln 15ml
- Atropine Sul 0.1mg/ml Inj, 5ml
- Atropine Sulf 1% Oph Soln 5ml
- Atropine Sulf 1% Oph Soln 2ml
- Atropine Sulf 1% Oph Soln 15ml
- Atropine Sulfate 0.1mg/ml Inj, 10ml
- Atropine Sul 0.4mg/ml Inj, 20ml
- Atropine Sulfate 0.4mg/ml Inj 1ml
- Atropine Sul 0.4mg/ml Inj, 20ml
- Atropine Sulf 1% Oph Soln 10ml
- Atropine Sul 0.05mg/1ml Inj, 5ml
Dosing & Administration
Adult Dosing
Standard Dose:
Varies by indication
Condition-Specific Dosing:
Bradycardia (ACLS):
0.5 mg IV push every 3-5 minutes, maximum total dose 3 mg
Preoperative (to reduce secretions):
0.4-0.6 mg IM/SC 30-60 minutes prior to surgery
Organophosphate or Carbamate Poisoning:
Initial 1-2 mg IV/IM, repeat every 5-10 minutes until atropinization (dry mouth, clear lungs, heart rate >80 bpm, dilated pupils)
Cholinergic Crisis:
1-2 mg IV/IM, repeat as needed
Pediatric Dosing
Neonatal:
Not established for routine use; consult specific guidelines for emergency use (e.g., bradycardia: 0.02 mg/kg IV/IO, minimum 0.1 mg, maximum single dose 0.5 mg)
Infant:
Bradycardia: 0.02 mg/kg IV/IO, minimum 0.1 mg, maximum single dose 0.5 mg. Preoperative: 0.01 mg/kg IM/SC (max 0.4 mg)
Child:
Bradycardia: 0.02 mg/kg IV/IO, minimum 0.1 mg, maximum single dose 0.5 mg (total max 1 mg for child, 3 mg for adolescent). Preoperative: 0.01 mg/kg IM/SC (max 0.4 mg). Organophosphate poisoning: 0.02-0.05 mg/kg IV/IM, repeat every 10-20 minutes until atropinization.
Adolescent:
Bradycardia: 0.02 mg/kg IV/IO, minimum 0.1 mg, maximum single dose 0.5 mg (total max 3 mg). Preoperative: 0.4-0.6 mg IM/SC. Organophosphate poisoning: 1-2 mg IV/IM, repeat every 5-10 minutes until atropinization.
Dose Adjustments
Renal Impairment:
Mild:
No specific adjustment recommended.
Moderate:
No specific adjustment recommended; use with caution.
Severe:
Use with caution; consider reduced doses and extended intervals due to prolonged elimination half-life. Monitor for anticholinergic effects.
Dialysis:
Atropine is not significantly removed by dialysis. Use with caution, monitor for effects.
Hepatic Impairment:
Mild:
No specific adjustment recommended.
Moderate:
No specific adjustment recommended; use with caution.
Severe:
Use with caution; monitor for increased anticholinergic effects as hepatic metabolism may be impaired.
Pharmacology
Mechanism of Action
Atropine is a competitive antagonist of acetylcholine at muscarinic receptors. It blocks the effects of acetylcholine at postganglionic parasympathetic neuroeffector sites, including smooth muscle, cardiac muscle, and glands. This blockade leads to increased heart rate, decreased glandular secretions (salivary, bronchial, sweat), relaxation of smooth muscles (bronchi, GI tract, bladder), and mydriasis and cycloplegia.
Pharmacokinetics
Absorption:
Bioavailability:
Not applicable for IV administration; rapid and complete absorption after IM/SC.
Tmax:
IV: immediate; IM: 30 minutes; SC: 1 hour
FoodEffect:
Not applicable for injectable formulation.
Distribution:
Vd:
Approximately 2-4 L/kg
ProteinBinding:
Approximately 14-20%
CnssPenetration:
Yes
Elimination:
HalfLife:
Approximately 2-4 hours (longer in children and elderly)
Clearance:
Approximately 0.5 L/kg/hr
ExcretionRoute:
Renal (urine)
Unchanged:
Approximately 30-50% (as unchanged drug)
Pharmacodynamics
OnsetOfAction:
IV: within 1 minute; IM: 10-30 minutes; SC: 30-60 minutes
PeakEffect:
IV: 2-4 minutes (cardiac effects); IM/SC: 30-60 minutes
DurationOfAction:
4-6 hours (cardiac effects may be shorter, ocular effects longer)
Safety & Warnings
Side Effects
Serious Side Effects: Seek Medical Help Right Away
While rare, some people may experience severe and potentially life-threatening side effects when taking this medication. If you notice any of the following symptoms, contact your doctor or seek medical attention immediately:
Signs of an allergic reaction, such as:
+ Rash
+ Hives
+ Itching
+ Red, swollen, blistered, or peeling skin with or without fever
+ Wheezing
+ Tightness in the chest or throat
+ Trouble breathing, swallowing, or talking
+ Unusual hoarseness
+ Swelling of the mouth, face, lips, tongue, or throat
Urination problems
Chest pain or pressure, rapid heartbeat, or irregular heartbeat
Severe dizziness or fainting
Breathing difficulties, slow breathing, or shallow breathing
Confusion
Balance problems
Hallucinations (seeing or hearing things that are not there)
Extreme fatigue or weakness
Restlessness
Shakiness
Abdominal swelling
Severe constipation or stomach pain, which may indicate a serious bowel problem
Erectile dysfunction or decreased libido
Depression
Changes in vision, eye pain, or severe eye irritation
Inability to sweat during physical activity or in warm temperatures
Other Possible Side Effects
Like all medications, this drug can cause side effects. Although many people may not experience any side effects or only minor ones, it's essential to discuss any concerns with your doctor. If you experience any of the following side effects or any other unusual symptoms that bother you or persist, contact your doctor for guidance:
Blurred vision
Sensitivity to bright lights
Constipation
Stomach pain
Nausea or vomiting
Decreased sweating
Dizziness or headache
Dry mouth
Dry eyes
Dry nose
Dilated pupils
Flushing
Pain at the injection site
This list is not exhaustive, and you may experience other side effects not mentioned here. If you have questions or concerns about side effects, consult your doctor. You can also report side effects to the FDA at 1-800-332-1088 or online at https://www.fda.gov/medwatch.
While rare, some people may experience severe and potentially life-threatening side effects when taking this medication. If you notice any of the following symptoms, contact your doctor or seek medical attention immediately:
Signs of an allergic reaction, such as:
+ Rash
+ Hives
+ Itching
+ Red, swollen, blistered, or peeling skin with or without fever
+ Wheezing
+ Tightness in the chest or throat
+ Trouble breathing, swallowing, or talking
+ Unusual hoarseness
+ Swelling of the mouth, face, lips, tongue, or throat
Urination problems
Chest pain or pressure, rapid heartbeat, or irregular heartbeat
Severe dizziness or fainting
Breathing difficulties, slow breathing, or shallow breathing
Confusion
Balance problems
Hallucinations (seeing or hearing things that are not there)
Extreme fatigue or weakness
Restlessness
Shakiness
Abdominal swelling
Severe constipation or stomach pain, which may indicate a serious bowel problem
Erectile dysfunction or decreased libido
Depression
Changes in vision, eye pain, or severe eye irritation
Inability to sweat during physical activity or in warm temperatures
Other Possible Side Effects
Like all medications, this drug can cause side effects. Although many people may not experience any side effects or only minor ones, it's essential to discuss any concerns with your doctor. If you experience any of the following side effects or any other unusual symptoms that bother you or persist, contact your doctor for guidance:
Blurred vision
Sensitivity to bright lights
Constipation
Stomach pain
Nausea or vomiting
Decreased sweating
Dizziness or headache
Dry mouth
Dry eyes
Dry nose
Dilated pupils
Flushing
Pain at the injection site
This list is not exhaustive, and you may experience other side effects not mentioned here. If you have questions or concerns about side effects, consult your doctor. You can also report side effects to the FDA at 1-800-332-1088 or online at https://www.fda.gov/medwatch.
Seek Immediate Medical Attention If You Experience:
- Severe dry mouth
- Difficulty urinating
- Blurred vision or sensitivity to light
- Feeling hot or flushed
- Confusion or agitation
- Fast or irregular heartbeat
Before Using This Medicine
Before Taking This Medication: Important Information to Share with Your Doctor
It is essential to inform your doctor about the following:
Any allergies you have, including allergies to this medication, any of its components, or other substances, such as foods or drugs. Be sure to describe the symptoms you experienced as a result of the allergy.
All medications you are currently taking, including prescription and over-the-counter (OTC) drugs, natural products, and vitamins. This information will help your doctor identify potential interactions between this medication and other substances.
* Any health problems you have, as this medication may interact with certain conditions.
To ensure your safety, it is crucial to verify that it is safe to take this medication with all your other medications and health conditions. Never start, stop, or change the dose of any medication without first consulting your doctor.
It is essential to inform your doctor about the following:
Any allergies you have, including allergies to this medication, any of its components, or other substances, such as foods or drugs. Be sure to describe the symptoms you experienced as a result of the allergy.
All medications you are currently taking, including prescription and over-the-counter (OTC) drugs, natural products, and vitamins. This information will help your doctor identify potential interactions between this medication and other substances.
* Any health problems you have, as this medication may interact with certain conditions.
To ensure your safety, it is crucial to verify that it is safe to take this medication with all your other medications and health conditions. Never start, stop, or change the dose of any medication without first consulting your doctor.
Precautions & Cautions
Important Warnings and Cautions
It is essential to inform all your healthcare providers, including doctors, nurses, pharmacists, and dentists, that you are taking this medication.
To minimize the risk of dehydration, be cautious in hot weather or during physical activity, and drink plenty of fluids to prevent fluid loss.
Accidental Ingestion
If this medication is swallowed, immediately contact a doctor or a poison control center, as it may cause harm.
Special Precautions
If you are 65 years or older, use this medication with caution, as you may be more susceptible to side effects.
When administering this medication to children, exercise caution, as the risk of certain side effects may be higher in this population.
Pregnancy and Breastfeeding
If you are pregnant, plan to become pregnant, or are breastfeeding, consult your doctor to discuss the potential benefits and risks to you and your baby.
Multi-Dose Container Warning
Some products contain benzyl alcohol. To minimize the risk of serious side effects in newborns and infants, try to avoid products with benzyl alcohol whenever possible. Benzyl alcohol can cause severe adverse effects in these children, particularly when combined with other medications containing benzyl alcohol. Consult your doctor to determine if this product contains benzyl alcohol and to discuss alternative options.
It is essential to inform all your healthcare providers, including doctors, nurses, pharmacists, and dentists, that you are taking this medication.
To minimize the risk of dehydration, be cautious in hot weather or during physical activity, and drink plenty of fluids to prevent fluid loss.
Accidental Ingestion
If this medication is swallowed, immediately contact a doctor or a poison control center, as it may cause harm.
Special Precautions
If you are 65 years or older, use this medication with caution, as you may be more susceptible to side effects.
When administering this medication to children, exercise caution, as the risk of certain side effects may be higher in this population.
Pregnancy and Breastfeeding
If you are pregnant, plan to become pregnant, or are breastfeeding, consult your doctor to discuss the potential benefits and risks to you and your baby.
Multi-Dose Container Warning
Some products contain benzyl alcohol. To minimize the risk of serious side effects in newborns and infants, try to avoid products with benzyl alcohol whenever possible. Benzyl alcohol can cause severe adverse effects in these children, particularly when combined with other medications containing benzyl alcohol. Consult your doctor to determine if this product contains benzyl alcohol and to discuss alternative options.
Overdose Information
Overdose Symptoms:
- Severe dry mouth and throat
- Difficulty swallowing and speaking
- Blurred vision, dilated pupils, photophobia
- Hot, dry, flushed skin
- Fever
- Tachycardia, palpitations, arrhythmias
- Urinary urgency and retention
- Reduced bowel sounds, constipation
- Restlessness, excitement, delirium, hallucinations, psychosis
- Ataxia, tremors, convulsions
- Respiratory depression, coma (severe cases)
What to Do:
Seek immediate medical attention. Call 911 or Poison Control (1-800-222-1222). Treatment is supportive and may include physostigmine (a cholinesterase inhibitor) to reverse anticholinergic effects, especially CNS symptoms.
Drug Interactions
Major Interactions
- Other anticholinergic drugs (e.g., tricyclic antidepressants, antihistamines, phenothiazines, quinidine, disopyramide) - additive anticholinergic effects
- Potassium chloride (solid oral dosage forms) - increased risk of GI lesions due to delayed gastric emptying
Moderate Interactions
- Drugs that prolong QT interval (e.g., antiarrhythmics, antipsychotics) - theoretical risk of additive QT prolongation, though atropine primarily affects heart rate
- Antacids, antidiarrheals (adsorbent type) - may reduce absorption of atropine if given orally (not relevant for injection)
- Metoclopramide, cisapride - atropine antagonizes their prokinetic effects
Monitoring
Baseline Monitoring
Heart Rate and Rhythm (ECG)
Rationale: To assess baseline cardiac status and monitor response to atropine, especially in bradycardia.
Timing: Prior to administration
Blood Pressure
Rationale: To assess hemodynamic stability.
Timing: Prior to administration
Respiratory Rate and Depth
Rationale: To assess respiratory status, especially in poisoning cases.
Timing: Prior to administration
Pupil Size and Reactivity
Rationale: To assess baseline and monitor for anticholinergic effects (mydriasis).
Timing: Prior to administration
Routine Monitoring
Heart Rate and Rhythm (ECG)
Frequency: Continuously or every 5-15 minutes during acute treatment, then as clinically indicated.
Target: Increase in HR for bradycardia; HR >80 bpm for organophosphate poisoning.
Action Threshold: Lack of response, excessive tachycardia, or arrhythmias.
Blood Pressure
Frequency: Every 5-15 minutes during acute treatment, then as clinically indicated.
Target: Maintain adequate perfusion.
Action Threshold: Hypotension or hypertension.
Respiratory Status (Rate, Depth, Secretions)
Frequency: Continuously or every 5-15 minutes, especially in poisoning.
Target: Clear lungs, decreased secretions.
Action Threshold: Increased secretions, bronchospasm, respiratory distress.
Mental Status
Frequency: Every 15-30 minutes, then as clinically indicated.
Target: Alert and oriented, or appropriate for clinical situation.
Action Threshold: Agitation, delirium, confusion, somnolence.
Urine Output
Frequency: Every 1-4 hours, or as clinically indicated.
Target: Adequate urine output.
Action Threshold: Urinary retention.
Symptom Monitoring
- Dry mouth
- Blurred vision
- Photophobia
- Urinary retention
- Constipation
- Flushing
- Hot, dry skin
- Fever
- Agitation
- Delirium
- Hallucinations
- Tachycardia
- Arrhythmias
Special Patient Groups
Pregnancy
Category C. Use only if the potential benefit justifies the potential risk to the fetus. Atropine crosses the placenta.
Trimester-Specific Risks:
First Trimester:
Limited data, but no clear evidence of teratogenicity in humans. Animal studies show some adverse effects at high doses.
Second Trimester:
Generally considered safe for acute, life-saving use.
Third Trimester:
May cause fetal tachycardia. Use with caution near term, especially during labor, as it may inhibit uterine contractions.
Lactation
L3 (Moderately safe). Atropine is excreted into breast milk in small amounts. May cause anticholinergic effects in the infant (e.g., drowsiness, constipation, dry mouth) or reduce milk supply.
Infant Risk:
Low risk for single, acute doses. Monitor infant for anticholinergic effects (e.g., irritability, constipation, drowsiness) and for adequate feeding/hydration.
Pediatric Use
Children, especially infants and young children, are more susceptible to the toxic effects of atropine, particularly fever and CNS effects. Dosing must be precise (0.02 mg/kg). Close monitoring is essential.
Geriatric Use
Elderly patients are more sensitive to the anticholinergic effects of atropine, especially CNS effects (confusion, delirium), urinary retention, and constipation. Use with caution and consider lower initial doses.
Clinical Information
Clinical Pearls
- Atropine is a critical medication in ACLS for symptomatic bradycardia and is the primary antidote for organophosphate poisoning.
- In organophosphate poisoning, continue atropine until signs of atropinization (e.g., dry mouth, clear lungs, heart rate >80 bpm, dilated pupils) are achieved, which may require very large doses.
- Atropine is ineffective for bradycardia due to heart transplant (denervated heart) or hypothermia.
- Monitor for anticholinergic toxicity ('hot as a hare, blind as a bat, dry as a bone, red as a beet, mad as a hatter').
- For pre-operative use, administer 30-60 minutes prior to induction to allow time for effect.
Alternative Therapies
- For symptomatic bradycardia: Epinephrine, dopamine, transcutaneous pacing, transvenous pacing.
- For organophosphate poisoning: Pralidoxime (2-PAM) is used in conjunction with atropine to reactivate acetylcholinesterase.
- For excessive secretions (pre-op): Glycopyrrolate (does not cross BBB, less CNS effects).
Cost & Coverage
Average Cost:
Varies significantly by supplier and quantity per 1ml vial
Generic Available:
Yes
Insurance Coverage:
Generally covered by most insurance plans as a generic injectable, often Tier 1 or 2.
General Drug Facts
If your symptoms or health problems do not improve or worsen over time, it is essential to contact your doctor for further guidance. To ensure your safety and the safety of others, never share your medication with anyone, and do not take medication prescribed to someone else.
Store all medications in a secure location, out of the reach of children and pets, to prevent accidental ingestion. When disposing of unused or expired medications, do not flush them down the toilet or pour them down the drain unless specifically instructed to do so by a healthcare professional or pharmacist. Instead, consult with your pharmacist to determine the best disposal method, as some communities have drug take-back programs in place.
Some medications may come with an additional patient information leaflet, so it is a good idea to check with your pharmacist for more information. If you have any questions or concerns about your medication, do not hesitate to reach out to your doctor, nurse, pharmacist, or other healthcare provider.
In the event of a suspected overdose, immediately contact your local poison control center or seek medical attention. Be prepared to provide detailed information about the overdose, including the type and amount of medication taken, as well as the time it was taken, to ensure you receive the proper care and treatment.
Store all medications in a secure location, out of the reach of children and pets, to prevent accidental ingestion. When disposing of unused or expired medications, do not flush them down the toilet or pour them down the drain unless specifically instructed to do so by a healthcare professional or pharmacist. Instead, consult with your pharmacist to determine the best disposal method, as some communities have drug take-back programs in place.
Some medications may come with an additional patient information leaflet, so it is a good idea to check with your pharmacist for more information. If you have any questions or concerns about your medication, do not hesitate to reach out to your doctor, nurse, pharmacist, or other healthcare provider.
In the event of a suspected overdose, immediately contact your local poison control center or seek medical attention. Be prepared to provide detailed information about the overdose, including the type and amount of medication taken, as well as the time it was taken, to ensure you receive the proper care and treatment.