The Effects of Atropine Sulfate:


  • Anticholinergic or anti-parasympathetic
  • Sometimes referred to as a parasympatholytic drug

A parasympatholytic agent is a substance or activity that reduces the parasympathetic nervous system’s activity. The parasympathetic nervous system is often conversationally described as the “Rest and Digest” portion of the autonomic nervous system.  Atropine blocks this action.

Atropine Indications for Use:

Atropine is one of the few ACLS medications that can be delivered via endotracheal tube. However, vascular access is preferable in most cases.

Atropine is the drug of choice for symptomatic sinus bradycardia. It may also be beneficial in the presence of atrioventricular nodal blocks.

Atropine Precautions & Contraindications:

Atropine use during pulseless electrical activity (PEA) and asystole does not usually have a therapeutic benefit.

Atropine will most likely not affect:

  • Type 2 second-degree or third degree AV block
  • Block in non-nodal tissue

Adult Dosage for Atropine:

Atropine can be given for bradycardia, with or without acute coronary syndrome

  • Give 0.5 mg every 3-5 minutes as needed
  • Do not exceed a total dose of .04 mg/kg to a total of 3mg
  • In severe clinical conditions, higher doses should be used with a shorter dosing interval such as every 3 minutes

To reverse the symptoms of organophosphate poisoning:

  • 2 to 4 mg or higher may be needed
  • Both intraosseous administration and intravenous infusion are effective for rapid delivery of atropine
  • Reconstitution of powdered atropine can be a viable option, especially in a mass casualty setting

Personal protective equipment should be utilized while treating patients of OP toxicity to reduce the risk of cross contamination of rescuers.