Classification:
Anticholinergic
Original Date:
August 2005
Revised Date:
December 2019
Indications:
- For relaxation of gastrointestinal, biliary and genitourinary tract mobility
- Suppression of salivary, gastric and respiratory secretions (preoperatively for respiratory effects)
- Symptomatic sinus bradycardia, heartblock
- Asystole
- Reversal of the muscarinic effects of cholinergic agents such as neostigmine, pyridostigmine, pesticides, poisoning from certain mushrooms
Reconstitution and Stability:
- Stable at room temperature
- Protect from light
Compatibility:
- Solutions Compatible: Normal Saline, Sterile Water for Injection
- Additives/Above Cassette Compatible: chlorpromazine, dimenhydrinate, diphenhydramine, droperidol, fentanyl citrate, hydroxyzine, meperidine, midazolam, morphine, pentazocine, promethazine, scopolamine. Use mixed solutions within 15 minutes.
- Y-site Compatible: KCl (up to 40 mmol/L), morphine
- Incompatible: norepinephrine, alkaline solutions
Administration:
(For approved routes of administration by nursing personnel, refer to Policy for the Administration of Intravenous Medications.)
| SC | YES |
| IM | YES, if injected into an extremity, elevate for 10-20 seconds Usual dilution: 0.05-1 mg/mL |
| IV Direct | YES Usual dilution: 0.05-1 mg/mL Infusion time: 1 minute |
| IV Intermittent Infusion | NO |
| IV Continuous Infusion | NO |
Dosage:
(For neonatal dosages, refer to Neonatal IV Drug Manual.)
Pediatric: (> 5 kg)
- Pre-Operative: 0.01-0.02 mg/kg/dose IM/IV/SC 30-60 minutes pre-op, then Q 4-6 hours PRN. Maximum : 0.4 mg/dose
- CPR (bradycardia): 0.02 mg/kg/dose IV Q 3-5 minutes.
Maximum cumulative dose: 0.04 mg/kg or 2 mg, whichever is less
Maximum single dose: 0.5 mg in children or 1 mg in adolescents - Organophosphate poisoning: 0.05 mg/kg/dose Q 10-15 minutes until atropine effect seen, then Q 1-4 hours to maintain atropine effect for 24 hours (as per poison control)
Adult:
- Pre-Operative: 0.4 - 0.6 mg IM/IV/SC 30-60 minutes preop, then Q 4-6 hours PRN
- Organophosphate poisoning: 1-2 mg/dose Q 10-20 minutes until atropine effect seen,
then Q 1-4 hours to maintain atropine effect for 24 hours
Potential hazards of parenteral administration:
- Tachycardia, respiratory excitation then depression
- Anticholinergic side effects: agitation, anhidrosis, flushing, dry mouth, urinary retention, blurred vision, photophobia
- Paradoxical reactions can occur, eg. hyperexcitability or bradycardia, especially with high doses or slow IV administration
Notes:
- Injectable form may be given orally (well absorbed)
- Monitor heart rate