Atropine

Atropine Brands

Brand Name	Manufacturer Name	Distributor	Drug Strength	Packaging	Formulation	Formulation Strength	Price
Aurotrop	Aurolab	Medisel Kenya Ltd	1%	10ml	eye drops	per ml	KES 50
Cusi Atropine	Alcon Pharmaceuticals	Pan Pharmaceuticals Ltd	1%	10ml	eye drops	per ml	KES 240
Isopto-Atropine	Alcon Pharmaceuticals	Pan Pharmaceuticals Ltd	1%	5ml	eye drops	per ml	KES 270
Atropine	Dawa Limited	Dawa Limited	1mg	1ml	Injection	per vial	KES 8.00
Atropine	Laborate	Harley's Limited	1mg	1ml	Injection	per vial	KES 8.00

Atropine More info
Mode Of Action	Mydriatic and cycloplegic (e.g. atropine, cyclopentolate, tropicamide)
Drug Indication	Drying of bronchial and salivary secretions due to inhalations in anaethetics and intubations; prevention of the onset of bradycardia and other muscarinic action due to neostigmine; diagnosis of sinus node dysfunction and in the evaluation of coronary artery disease during atrial pacing; Organophosphorous poisoning as an antidote.
Precautions	Myasthenia gravis, renal and hepatic impairment, children, elderly, diarrhoea, glaucoma, hypertension, ulcerative colitis, Downs syndrome.
Contra-Indications	Prostate enlargement, paralytic ileus, pyloric stenosis, high ambient temperatures.
Side Effects	Dry mouth; blurred vision; cycloplegia; mydriasis; photophobia anhidrosis; urinary hesitancy and retention; tachycardia; increased ocular tension; loss of taste sensation; headache; nervousness; drowsiness; weakness; dizziness; flushing, insomnia; nausea and vomiting; bloated feeling; mental confusion and/or excitement (especially in geriatric patients).
Dosage	Premedication: By I.V inj 300-600mcg immediately before anaesthesia. Dose increased by 100mcg for the treatment of bradycardia. Organophosphorous poisoning: I.M or I.V 2mg every 20-30mins until the skin becomes dry, the pupils dilate and tachycardia develops.
Special Information	It is a classical antimuscurinic that is usually obtained by extraction from various members of the Solanaceae genus of plants including Atropa, Datura stramonium, or Duboisia myoporoides.
Pregnancy Category	Category A1:
Pregnancy Category Description	Drugs which have been taken by a sizeable number of pregnant women and women of child-bearing age with no any established rise in the frequency of malformations or other direct or indirect detrimental effects on the foetus having been noted.
Drug Category	ANAESTHETICS
Drug Sub-Category	Other Agents used in Anaesthesia

I.M., I.V., SubQ: 0.4-0.6 mg 30-60 minutes preop and repeat every 4-6 hours as needed.

Oral: 0.4 mg; may repeat in 4 hours if necessary; 0.4 mg initial dose may be exceeded in certain cases and may repeat in 4 hours if necessary

Bradycardia (Note: Atropine may be ineffective in heart transplant recipients): I.V.: 0.5 mg every 3-5 minutes, not to exceed a total of 3 mg or 0.04 mg/kg (ACLS, 2010)

Neuromuscular blockade reversal: I.V.: 25-30 mcg/kg 30-60 seconds before neostigmine or 7-10 mcg/kg 30-60 seconds before edrophonium

Organophosphate or carbamate poisoning: Note: The dose of atropine required varies considerably with the severity of poisoning. Total amount of atropine used in carbamate poisoning is usually less. Severely poisoned patients may exhibit significant tolerance to atropine; ≥2 times the suggested doses may be needed. Titrate to pulmonary status (decreased bronchial secretions). Once patient is stable for a period of time, the dose/dosing frequency may be decreased. If atropinization occurs after 1-2 mg of atropine then re-evaluate working diagnosis.

I.V.: Initial: 1-5 mg; doses should be doubled every 5 minutes until signs of muscarinic excess abate (clearing of bronchial secretions, bronchospasm, and adequate oxygenation). Overly aggressive dosing may cause anticholinergic toxicity (eg, delirium, hyperthermia, and muscle twitching).

I.M.: AtroPen®: Mild symptoms: Administer 2 mg as soon as exposure is known or suspected. If severe symptoms develop after first dose, 2 additional doses should be repeated in 10 minutes; do not administer more than 3 doses. Severe symptoms: Immediately administer three 2 mg doses.

Nerve agent toxicity management: I.M.: See Note. Prehospital (“in the field”) or hospital/emergency department: Mild-to-moderate symptoms: 2-4 mg; severe symptoms: 6 mg

Note: Pralidoxime is a component of the management of nerve agent toxicity; consult Pralidoxime for specific route and dose.

Prehospital (“in the field”) management: Repeat atropine I.M. (2 mg) at 5-10 minute intervals until secretions have diminished and breathing is comfortable or airway resistance has returned to near normal.

Hospital management: Repeat atropine I.M. (2 mg) at 5-10 minute intervals until secretions have diminished and breathing is comfortable or airway resistance has returned to near normal.

Mydriasis, cycloplegia (preprocedure): Ophthalmic (1% solution): Instill 1-2 drops 1 hour before the procedure.

Ointment: Apply a small amount in the conjunctival sac up to 3 times/day. Compress the lacrimal sac by digital pressure for 1-3 minutes after instillation.

Inhibit salivation and secretions (preanesthesia): Oral, I.M., I.V., SubQ: Neonates, Infants, and Children:

Children <5 kg: 0.02 mg/kg/dose 30-60 minutes preop then every 4-6 hours as needed. Use of a minimum dosage of 0.1 mg in neonates <5 kg will result in dosages >0.02 mg/kg. There is no documented minimum dosage in this age group.

Children >5 kg: 0.01-0.02 mg/kg/dose to a maximum 0.4 mg/dose 30-60 minutes preop; minimum dose: 0.1 mg

I.V., I.O.: Neonates, Infants, and Children: 0.02 mg/kg, minimum dose 0.1 mg, maximum single dose: 0.5 mg; may repeat once in 3-5 minutes to a maximum total dose of 0.04 mg/kg or 1 mg (PALS, 2010). When treating bradycardia in neonates, reserve use for those patients unresponsive to improved oxygenation and epinephrine.

Intratracheal: Infants and Children: 0.04-0.06 mg/kg; may repeat once if needed (PALS, 2010)

I.V.: Children: 0.03-0.05 mg/kg every 10-20 minutes until atropine effect, then every 1-4 hours for at least 24 hours

I.M. (AtroPen®): Children: Mild symptoms: Administer dose listed below as soon as exposure is known or suspected. If severe symptoms develop after first dose, 2 additional doses should be repeated in 10 minutes; do not administer more than 3 doses. Severe symptoms: Immediately administer 3 doses as follows:

<6.8 kg (15 lb): Use of AtroPen® formulation not recommended; administer atropine 0.05 mg/kg

Nerve agent toxicity management: I.M.: Infants and Children: See following Note.

Birth to <2 years: Mild-to-moderate symptoms: 0.05 mg/kg; severe symptoms: 0.1 mg/kg

Birth to <2 years: Mild-to-moderate symptoms: 0.05 mg/kg I.M. or 0.02 mg/kg I.V.; severe symptoms: 0.1 mg/kg I.M. or 0.02 mg/kg I.V.

Note: Pralidoxime is a component of the management of nerve agent toxicity; consult Pralidoxime for specific route and dose.

Prehospital (“in the field”) management: Repeat atropine I.M. (0.05-0.1 mg/kg) at 5-10 minute intervals until secretions have diminished and breathing is comfortable or airway resistance has returned to near normal.

Hospital management: Repeat atropine I.M. (infants: 1 mg; all others: 2 mg) at 5-10 minute intervals until secretions have diminished and breathing is comfortable or airway resistance has returned to near normal.

Prehospital (“in the field”): Mild-to-moderate symptoms: 1 mg; severe symptoms: 2-4 mg

Hospital/emergency department: Mild-to-moderate symptoms: 1 mg; severe symptoms: 2 mg

Note: Pralidoxime is a component of the management of nerve agent toxicity; consult Pralidoxime for specific route and dose.

Hospital management: Repeat atropine I.M. (2 mg) at 5-10 minute intervals until secretions have diminished and breathing is comfortable or airway resistance has returned to near normal.