How long should atropine be administered?

From the Guidelines

Atropine should be administered for as long as necessary to achieve the desired clinical effect, with a maximum dose of 3 mg, and repeated every 3-5 minutes as needed, according to the 2019 ACC/AHA/HRS guideline on the evaluation and management of patients with bradycardia and cardiac conduction delay 1. The duration of atropine administration depends on the underlying condition being treated, such as symptomatic sinus bradycardia or atrioventricular block.

• In emergency settings, atropine is given as a 0.5-1 mg IV bolus, which may be repeated every 3-5 minutes to a maximum dose of 3 mg, as stated in the guideline 1.
• The treatment should be monitored for signs of anticholinergic effects, such as pupil dilation, decreased secretions, or heart rate normalization.
• It is essential to adjust the dosing according to the patient's response and to minimize potential side effects, including dry mouth, blurred vision, urinary retention, and tachycardia. Key considerations for atropine administration include:
• The dosage and frequency of administration, as outlined in the guideline 1
• The patient's clinical response to treatment, including the presence of anticholinergic effects
• The potential for side effects and the need for dose adjustment to minimize these effects.

From the Research

Duration of Atropine Administration

• The duration of atropine administration can vary depending on the severity of the poisoning and the patient's response to treatment 2.
• In a study of 18 patients with severe organophosphate poisoning, the mean duration of treatment with atropine was 9.6 days, with a range of 1-24 days 2.
• Another study reported that atropine therapy was continued for approximately 72 hours in a patient with severe organophosphate poisoning 3.
• The dosage and duration of atropine administration may need to be adjusted based on the patient's symptoms and response to treatment, with some patients requiring higher doses or longer treatment durations 4, 5.

Factors Influencing Duration of Atropine Administration

• The severity of the poisoning and the patient's symptoms can influence the duration of atropine administration 3, 2.
• The use of other treatments, such as pralidoxime, may also impact the duration of atropine administration 3, 5.
• The patient's response to treatment and the presence of any adverse effects can also influence the duration of atropine administration 4, 5.

Guidelines for Atropine Administration

• Current guidelines recommend rapid atropinization, with some authorities suggesting that atropine doses can be doubled for faster escalation 5.
• The World Health Organization (WHO) recommendations for atropine administration in organophosphate poisoning are considered slow compared to other authorities 5.
• More research is needed to establish evidence-based guidelines for the treatment of organophosphate poisoning, including the optimal duration and dosage of atropine administration 5.