closely and further doses of naloxone hydrochloride
administered as necessary.ANTIMUSCARINICS
eiiiiF 489Atropine sulfate
lINDICATIONS AND DOSE
Bradycardia due to acute massive overdosage of beta-
blockers
▶BY INTRAVENOUS INJECTION
▶Child: 40 micrograms/kg (max. per dose 3 mg)
Treatment of poisoning by organophosphorus insecticide
or nerve agent (in combination with pralidoxime
chloride)
▶BY INTRAVENOUS INJECTION
▶Child: 20 micrograms/kg every 5 – 10 minutes (max. per
dose 2 mg) until the skin becomesflushed and dry, the
pupils dilate, and bradycardia is abolished, frequency
of administration dependent on the severity of
poisoning
Premedication
▶BY INTRAVENOUS INJECTION
▶Neonate: 10 micrograms/kg, to be administered
immediately before induction of anaesthesia.▶Child 1 month–11 years: 20 micrograms/kg, to be
administered immediately before induction of
anaesthesia (minimum 100 micrograms, max.
600 micrograms)
▶Child 12–17 years: 300 – 600 micrograms, to be
administered immediately before induction of
anaesthesia
▶BY SUBCUTANEOUS INJECTION, OR BY INTRAMUSCULAR
INJECTION
▶Neonate: 10 micrograms/kg, to be administered
30 – 60 minutes before induction of anaesthesia.▶Child 1 month–11 years: 10 – 30 micrograms/kg, to be
administered 30 – 60 minutes before induction of
anaesthesia (minimum 100 micrograms, max.
600 micrograms)
▶Child 12–17 years: 300 – 600 micrograms, to be
administered 30 – 60 minutes before induction of
anaesthesia
▶BY MOUTH
▶Neonate: 20 – 40 micrograms/kg, to be administered
1 – 2 hours before induction of anaesthesia.▶Child: 20 – 40 micrograms/kg (max. per dose
900 micrograms), to be administered 1 – 2 hours before
induction of anaesthesia
Intra-operative bradycardia
▶BY INTRAVENOUS INJECTION
▶Neonate: 10 – 20 micrograms/kg.▶Child 1 month–11 years: 10 – 20 micrograms/kg
▶Child 12–17 years: 300 – 600 micrograms, larger doses
may be used in emergencies
Control of muscarinic side-effects of neostigmine in
reversal of competitive neuromuscular block
▶BY INTRAVENOUS INJECTION
▶Neonate: 20 micrograms/kg.▶Child 1 month–11 years: 20 micrograms/kg (max. per dose
1. 2 mg)
▶Child 12–17 years: 0. 6 – 1. 2 mglUNLICENSED USENot licensed for use in children under
12 years for intra-operative bradycardia or by intravenous
route for premedication. Not licensed for use by oral route.IMPORTANT SAFETY INFORMATION
Antimuscarinic drugs used for premedication to general
anaesthesia should only be administered by, or under
the direct supervision of, personnel experienced in their
use.lINTERACTIONS→Appendix 1 : atropine
lSIDE-EFFECTS
▶Common or very common
▶With intravenous useAnhidrosis.anxiety.bronchial
secretion decreased.dysphagia.gastrointestinal disorders
.hallucination.hyperthermia.movement disorders.
speech disorder.taste loss.thirst.urticaria.visual
impairment
▶Rare or very rare
▶With intravenous useAngina pectoris.arrhythmias.
hypertensive crisis.seizure
▶Frequency not known
▶With intravenous useInsomnia
▶With oral useAngle closure glaucoma.bronchial secretion
altered.chest pain.dysphagia.fever.increased gastric
reflux.thirst
lPREGNANCYNot known to be harmful; manufacturer
advises caution.
lBREAST FEEDINGMay suppress lactation; small amount
present in milk—manufacturer advises caution.
lMONITORING REQUIREMENTS
▶Control of muscarinic side-effects of neostigmine in reversal of
competitive neuromuscular blockSince atropine has a shorter
duration of action than neostigmine, late unopposed
bradycardia may result; close monitoring of the patient is
necessary.
lDIRECTIONS FOR ADMINISTRATIONFor administrationby
mouth, injection solution may be given orally.
lEXCEPTIONS TO LEGAL CATEGORY
▶With intramuscular use or intravenous use or subcutaneous
usePrescription only medicine restriction does not apply
where administration is for saving life in emergency.lMEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug. Forms available from special-order
manufacturers include: oral suspension, oral solution, solution
for injection, solution for infusion
Tablet
▶Atropine sulfate (Non-proprietary)
Atropine sulfate 600 microgramAtropine 600 microgram tablets|
28 tabletP£ 52. 92 DT = £ 52. 92
Solution for injection
▶Atropine sulfate (Non-proprietary)
Atropine sulfate 100 microgram per 1 mlAtropine
500 micrograms/ 5 ml solution for injection pre-filled syringes| 1 pre-
filled disposable injectionP£ 13. 00 | 10 pre-filled disposable
injectionP£ 130. 00
Atropine sulfate 200 microgram per 1 mlAtropine 1 mg/ 5 ml
solution for injection pre-filled syringes| 1 pre-filled disposable
injectionP£ 7. 08 – £ 13. 00 | 10 pre-filled disposable injectionP
£ 130. 00
Atropine sulfate 300 microgram per 1 mlAtropine 3 mg/ 10 ml
solution for injection pre-filled syringes| 1 pre-filled disposable
injectionP£ 7. 08 – £ 13. 00 DT = £ 7. 11 | 10 pre-filled disposable
injectionP£ 130. 00
Atropine sulfate 400 microgram per 1 mlAtropine
400 micrograms/ 1 ml solution for injection ampoules|
10 ampouleP£ 90. 30 DT = £ 90. 30
Atropine sulfate 600 microgram per 1 mlAtropine
600 micrograms/ 1 ml solution for injection ampoules|
10 ampouleP£ 11. 71 DT = £ 11. 71
Atropine 600 micrograms/ 1 ml solution for injection pre-filled syringes
| 1 pre-filled disposable injectionP£ 7. 08810 Anaesthesia adjuvants BNFC 2018 – 2019
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