From the Guidelines
To administer atropine sublingually, place the appropriate dose of atropine under the patient's tongue and instruct them to allow it to dissolve completely without swallowing, with typical adult doses ranging from 0.4 to 0.6 mg, as recommended by recent guidelines 1. When administering atropine sublingually, it is crucial to ensure the patient's mouth is moist, as a dry mouth will slow absorption. The patient should avoid eating, drinking, or smoking until the medication is completely absorbed.
Key Considerations
- Sublingual administration allows atropine to bypass first-pass metabolism in the liver, resulting in faster onset of action (within 5-10 minutes) compared to oral administration, making it particularly useful in emergency situations where rapid anticholinergic effects are needed, such as managing bradycardia, certain poisonings, or excessive secretions.
- Monitor the patient for common side effects including dry mouth, blurred vision, urinary retention, tachycardia, and confusion, as noted in studies 1.
- Sublingual atropine is contraindicated in patients with glaucoma, prostatic hypertrophy, or certain cardiac conditions, emphasizing the need for careful patient selection and monitoring.
Administration Details
- The recommended dose for adults is typically in the range of 0.4 to 0.6 mg, while pediatric doses are weight-based, usually around 0.01-0.02 mg/kg, although specific dosing may vary based on the clinical scenario and patient response.
- It is essential to follow the most recent guidelines for atropine administration, such as those provided by the American Heart Association 1, to ensure evidence-based practice and optimal patient outcomes.
From the Research
Administration of Atropine Sublingually
To administer atropine sublingually, it is essential to follow the proper procedure to ensure safety and efficacy.
- The dosage of atropine can vary, but studies have used doses ranging from 0.5 mg to 1.2 mg sublingually 2, 3.
- Atropine 1% ophthalmic solution can be administered sublingually for the management of terminal respiratory secretions or sialorrhea 4, 5.
- Sublingual atropine has been shown to be safe and well-tolerated, with minimal side effects 2, 3, 6.
- The bioavailability of sublingual atropine is comparable to intravenous administration, with peak plasma concentrations occurring within 10-15 minutes 2, 6.
Procedure for Sublingual Administration
- Place the prescribed dose of atropine under the tongue 3, 5.
- Allow the atropine to dissolve completely before swallowing 4.
- Monitor the patient for any adverse effects, such as dry mouth, blurred vision, or changes in heart rate or blood pressure 2, 3, 6.
Considerations and Precautions
- Sublingual atropine should only be administered under the guidance of a healthcare professional 2, 3, 4, 6, 5.
- Patients with certain medical conditions, such as glaucoma or urinary retention, may need to use atropine with caution 2, 3.
- Atropine can interact with other medications, so it is essential to inform the healthcare provider about all medications being taken 2, 3, 6.