se for ET administration with a second dose administered if indicated. Flush the ET tube with 0.9% Sodium Chloride Injection (1 to 5 mL for neonates and 5 mL or more for infants, children, and adolescents) and follow with 5 ventilations. Do not interrupt CPR to administer drug therapy.
For pre-operative use to decrease secretions (i.e., aspiration prophylaxis), as well as block cardiovagal reflexes and/or succinylcholine-induced arrhythmias, during surgery.
Oral Dosage
Adults
2 mg PO 30 to 60 minutes prior to anesthesia.
Intravenous, Intramuscular, or Subcutaneous dosage
Adults
0.2 to 1 mg (the usual dose is 0.4 mg) IV, IM, or subcutaneous 30 to 60 minutes prior to anesthesia.
Infants, Children, and Adolescents
0.01 to 0.02 mg/kg/dose IV or IM (minimum dose: 0.1 mg; Max: 1 mg) before administration of sedative/anesthetic and paralytic agents. According to the FDA-approved product labeling, dose may also be given subcutaneously 30 minutes before surgery. Various fixed dosing schedules are also available. The following is one example: 0.1 mg for patient weight 3.2 to 7 kg; 0.15 mg for weight 8 to 11 kg; 0.2 mg for weight 11 to 18 kg; 0.3 mg for weight 18 to 29 kg; and 0.4 mg for weight 30 to 41 kg.
Neonates
0.02 mg/kg/dose IV, IM, or subcutaneous before administration of sedative/anesthetic and paralytic agents. Use of 0.1 mg in neonates will result in dosages greater than 0.02 mg/kg; there is no documented minimum dosage in this age group.
For the treatment of cholinergic crisis (e.g., chemical nerve agent or organophosphate insecticide toxicity).
NOTE: Start atropine as soon as symptoms of toxicity occur. A survey of accidental auto-injections of atropine in children found that even relatively large doses (up to 0.175 mg/kg) were not associated with mortality or life-threatening complications (i.e., seizures, arrhythmias). In 48% of children (116/240), systemic atropine effects were noted, with 8% experiencing severe atropinization. Severity of atropinization was dose-related in a non-linear fashion.
Intravenous, Intramuscular, or Intraosseous† dosage (using parenteral solution; NOT autoinjector)
Adults
Administer 1 to 2 mg IV or IM initially; repeat every 20 to 30 minutes as needed until symptoms dissipate. IV route is preferred. In severe cases, the initial dose can be as large as 2 to 6 mg administered IV. Repeat doses of 2 to 6 mg can be administered IV or IM every 5 to 60 minutes. Up to 50 mg of atropine may be necessary in the first 24 hours. Therapy may be necessary for 48 hours or more, but lower doses administered orally may suffice after the acute phase has been stabilized.
Neonates, Infants, Children and Adolescents
0.05 to 0.1 mg/kg/dose IV, IM, or IO every 5 to 15 minutes as needed until symptoms dissipate. IV route is preferred. Repeat doses based on recurrence of symptoms for 2 to 12 hours or longer depending on severity of poisoning. When symptoms are stable for 6 hours or more, the dosing may be decreased. In severely poisoned patients, the dose may need to be more than 2 times suggested dose. The dosing interval may be decreased or continuous IV infusion may be necessary with high atropine requirements. If continuous infusion is required to maintain atropinization, begin with 10% to 20% of the total loading dose administered hourly.
Intramuscular dosage (AtroPen auto-injector only)
Adults, Adolescents, Children, Infants, and Neonates
Dosage is based on weight and symptoms: weight less than 7 kg, give 0.25 mg/dose I |
