.
NOTE: Atropine may be administered in higher initial doses for bradycardia resulting from acetylcholinesterase-inhibiting agents; large total doses may be required.
Intravenous or Intraosseus† dosage
Adults
0.5 mg IV every 3 to 5 minutes as needed up to 3 mg. Clinical practice guidelines suggest atropine if bradycardia produces signs and symptoms of instability (e.g., acutely altered mental status, ischemic chest discomfort, acute heart failure, hypotension, or other signs of shock that persist despite adequate airway and breathing). The same dosage may be given via the intraosseous route when IV access is not available. Doses less than 0.5 mg IV have been associated with paradoxical bradycardia. Atropine administration should not delay external pacing for patients with poor perfusion.
Infants, Children, and Adolescents
0.02 mg/kg/dose IV (minimum dose: 0.1 mg IV) is recommended by PALS; the dose may be repeated 1 time. Max: 0.5 mg/dose IV. The same dosage may be given via the intraosseous route when IV access is not available.
Neonates
0.02 mg/kg/dose IV; may repeat dose 1 time. Per PALS, the minimum single dose is 0.1 mg, however, some argue that this may be an excessive dose in very small neonates since the total dosage would be greater than 0.02 mg/kg. The same dosage may be given via the intraosseous route when IV access is not available.
Endotracheal dosage
NOTE: Drug effects after endotracheal (ET) administration may not be uniform; use only if access to IV or IO routes is not available.
Adults
1 to 2 mg ET (diluted in no more than 10 mL of 0.9% Sodium Chloride Injection or Sterile Water for Injection) per product labeling for FDA-approved indications. Clinical practice guidelines do not include the endotracheal administration of atropine.
Infants, Children, and Adolescents
0.04 to 0.06 mg/kg/dose ET (minimum dose: 0.1 mg ET); may repeat dose 1 time. Max: 0.5 mg/dose ET. Flush the ET tube with a minimum of 5 mL 0.9% Sodium Chloride Injection and follow with 5 ventilations. The optimal dosage has not been established.
Neonates
0.01 to 0.03 mg/kg/dose ET; may repeat dose 1 time. Flush the ET tube with a minimum of 1 to 5 mL (dependent on body weight with smaller patients getting smaller volumes) 0.9% Sodium Chloride Injection and follow with 5 ventilations.
Intramuscular dosage
Neonates, Infants, Children, and Adolescents
0.02 to 0.04 mg/kg/dose IM.
For the treatment of moderate amblyopia†.
Ophthalmic Dosage
Children
1 drop of 1% solution instilled in the unaffected eye once daily results in comparable improvement in visual acuity to patching. In a clinical trial, 419 children ages 3 to 7 years with moderate amblyopia (i.e., visual acuity 20/40 to 20/100) were randomly assigned to receive patching for a minimum of 6 hours daily or 1 drop of atropine 1% ophthalmic solution in the unaffected eye every day. Although more rapid improvement was noted initially in the patching group, the difference was clinically insignificant after 6 months (about one-third of a line). After the initial 6 months of treatment, investigators were permitted to prescribe any type of amblyopia therapy. In 363 patients, visual acuity continued to be improved when eva luated 2 years after initial randomization; the authors concluded that use of atropine or patching for 6 months followed by regular care did not lend to differences in visual acuity 2 years later. Additionally, in a subgroup analysis of 176 children who were eva luated at a |
