Parenteral Manual


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Original Date: 
August 2005
Revised Date: 
December 2019
  • 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

- 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


(For approved routes of administration by nursing personnel, refer to Policy for the Administration of Intravenous Medications.)

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

(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)


  •  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
  • Injectable form may be given orally (well absorbed)
  • Monitor heart rate

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