Lippincott Nursing Pocket Card - April 2022

Atropine Sulfate - Indications and Dosage


Atropine Sulfate - Indications and Dosage

Atropine is an anticholinergic drug – a competitive, reversible antagonist of muscarinic receptors. Atropine may be administered subcutaneously, intramuscularly (IM), intravenously (IV) or by endotracheal tube (ET). Intravenous is the preferred method. For ET administration, dilute 1 mg to 2 mg in 10 mL of sterile water or normal saline (McLendon & Preuss, 2021).

Atropine Sulfate
(Facts and Comparisons, 2022)
Approved Indications Dosage
Bradycardia during neuromuscular blockade reversal
  • 5 to 7 mcg/kg IV when administered with edrophonium
  • 15 to 20 mcg/kg IV when administered with neostigmine
  • Maximum total dosage: 3 mg
Sinus bradycardia, symptomatic
  • 0.5 to 1 mg IV or IM every 3 to 5 minutes
  • 1 mg is preferred for severe bradyarrhythmias (i.e., hypotension/shock, altered mental status, acute heart failure)
  • Endotracheal: 1 to 2 mg every 3 to 5 minutes
  • Maximum total dosage: 3 mg
Preoperative/preanesthetic medication to inhibit salivation and secretion
  • 0.5 to 1 mg IM, IV or subcutaneously 30 to 60 minutes preoperatively; repeat very 4 to 6 hours as needed
  • Maximum total dosage: 3 mg
Treatment of symptoms from muscarine-containing mushroom poisoning
  • 1 to 2 mg IV; titrate and repeat as needed to reverse symptoms (i.e., titrate to decreased bronchial secretions)
Antidote for anticholinesterase poisoning (carbamate insecticides, nerve agents, organophosphate insecticides)
  • Mild to Moderate symptoms: 1 to 2 mg IV bolus; repeat by doubling the dose every 3 to 5 minutes if previous dose did not induce a response; repeat doses as needed for 2 to 12 hours for recurrence of symptoms; consider starting IV continuous infusion for improved clinical outcomes.
  • Severe symptoms: 3 to 5 mg IV bolus and repeat as above; consider IV continuous infusion.


Note: The safety and efficacy of atropine in pediatric patients has not been fully studied. Consult the complete product insert for pediatric dosing.

Facts and Comparisons (2022, April 4). Atropine Injection.
McLendon, K. & Preuss, C.V. (2021, September 12). Atropine. StatPearls.