What is the dose of atropine (antimuscarinic agent) for controlling secretions?

From the Guidelines

Atropine should be dosed at 0.02 mg/kg IV/IO, with a minimum dose of 0.1 mg and a maximum single dose of 0.5 mg, for controlling secretions, as recommended by the 2010 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care 1. The dose of atropine can be repeated once if needed, and it is essential to consider the patient's weight and clinical response when administering the medication.

• Key considerations for atropine administration include:
  • IV/IO dose: 0.02 mg/kg
  • Minimum dose: 0.1 mg
  • Maximum single dose: 0.5 mg
  • Repeat dose: once if needed It is crucial to note that atropine works by blocking muscarinic acetylcholine receptors, reducing secretion production from salivary, bronchial, and gastrointestinal glands.
• Potential side effects of atropine include:
  • Dry mouth
  • Blurred vision
  • Urinary retention
  • Confusion, particularly in elderly patients Alternative anticholinergics, such as glycopyrrolate, may be considered, especially if patients experience significant side effects from atropine.
• Glycopyrrolate has fewer central nervous system effects compared to atropine, as it does not cross the blood-brain barrier as readily, and can be dosed at 0.1-0.2 mg IV/SC every 4 hours. Treatment with atropine or alternative anticholinergics should be adjusted based on clinical response and side effect profile, prioritizing the patient's morbidity, mortality, and quality of life outcomes.

From the FDA Drug Label

Adult dosage Antisialagogue or for antivagal effects: Initial single dose of 0. 5 to 1 mg. The dose of atropine for controlling secretions is 0.5 to 1 mg as an initial single dose. 2

From the Research

Dose of Atropine for Controlling Secretions

• The dose of atropine for controlling secretions is not consistently defined across studies, but various doses have been investigated:
  • 10 microgram/kg 3
  • 20 microgram/kg 3, 4
  • 30 microgram/kg 3
  • 0.01 mg/kg 5
  • 600-μg dose of sublingual atropine drops 6
• These studies suggest that atropine can be effective in controlling secretions, but the optimal dose may vary depending on the specific context and population being treated.

Comparison with Glycopyrrolate

• Some studies have compared the effectiveness of atropine with glycopyrrolate, another anticholinergic agent:
  • Glycopyrrolate was found to be more effective in controlling secretions and producing a more stable cardiovascular response than atropine in some studies 4, 7
  • However, other studies have found that atropine can be effective in reducing secretions, particularly in specific contexts such as clozapine-induced hypersalivation 6

Clinical Considerations

• The choice of atropine dose and the decision to use atropine versus glycopyrrolate may depend on various clinical factors, including the specific patient population, the procedure being performed, and the potential risks and benefits of each medication.
• Further research is needed to fully understand the optimal dosing and use of atropine for controlling secretions in different clinical contexts 5, 6