Usual Adult Dose for Bradyarrhythmia

0.4 to 1 mg, IV, every 1 to 2 hours as needed

• Larger doses, up to a maximum of 2 mg, may be required

Use: To overcome severe bradycardia and syncope due to a hyperactive carotid sinus reflex

Usual Adult Dose for Anesthesia

0.4 mg to 0.6 mg, IV, intramuscularly, or subcutaneously

Comments:

• Doses may be considerably exceeded in certain cases.

Uses:

• Treatment of parkinsonism; rigidity and tremor relieved by the apparently selective depressant action
• Relieve pylorospasm, hypertonicity of the small intestine, and hypermotility of the colon
• Relieve hypertonicity of the uterine muscle
• Relax the spasm of biliary and ureter colic and bronchial spasm
• Diminish the tone of the detrusor muscle of the urinary bladder in the treatment of urinary tract disorders
• Control the crying and laughing episode in patients with brain lesions
• Closed head injuries which cause acetylcholine to be released or present in the cerebrospinal fluid, causing abnormal EEG patterns, stupor, and neurological signs
• Management of peptic ulcer
• In anesthesia to control excessive salivation and bronchial secretions
• Control rhinorrhea of acute rhinitis or hay fever
• Antidote for pilocarpine, physostigmine, isoflurophate, choline esters, certain species of Aminata mushrooms, and anticholinesterase insecticide poisoning
• To lessen the degree of atrioventricular heart block when increased vagal tone is a major factor in the conduction defect, as in some cases due to digitalis

Usual Adult Dose for Anticholinesterase Poisoning

0.4 mg to 0.6 mg, IV, intramuscularly, or subcutaneously

Comments:

• Doses may be considerably exceeded in certain cases.

Uses:

• Treatment of parkinsonism; rigidity and tremor relieved by the apparently selective depressant action
• Relieve pylorospasm, hypertonicity of the small intestine, and hypermotility of the colon
• Relieve hypertonicity of the uterine muscle
• Relax the spasm of biliary and ureter colic and bronchial spasm
• Diminish the tone of the detrusor muscle of the urinary bladder in the treatment of urinary tract disorders
• Control the crying and laughing episode in patients with brain lesions
• Closed head injuries which cause acetylcholine to be released or present in the cerebrospinal fluid, causing abnormal EEG patterns, stupor, and neurological signs
• Management of peptic ulcer
• In anesthesia to control excessive salivation and bronchial secretions
• Control rhinorrhea of acute rhinitis or hay fever
• Antidote for pilocarpine, physostigmine, isoflurophate, choline esters, certain species of Aminata mushrooms, and anticholinesterase insecticide poisoning
• To lessen the degree of atrioventricular heart block when increased vagal tone is a major factor in the conduction defect, as in some cases due to digitalis

Usual Adult Dose for Rhinorrhea

0.4 mg to 0.6 mg, IV, intramuscularly, or subcutaneously

Comments:

• Doses may be considerably exceeded in certain cases.

Uses:

• Treatment of parkinsonism; rigidity and tremor relieved by the apparently selective depressant action
• Relieve pylorospasm, hypertonicity of the small intestine, and hypermotility of the colon
• Relieve hypertonicity of the uterine muscle
• Relax the spasm of biliary and ureter colic and bronchial spasm
• Diminish the tone of the detrusor muscle of the urinary bladder in the treatment of urinary tract disorders
• Control the crying and laughing episode in patients with brain lesions
• Closed head injuries which cause acetylcholine to be released or present in the cerebrospinal fluid, causing abnormal EEG patterns, stupor, and neurological signs
• Management of peptic ulcer
• In anesthesia to control excessive salivation and bronchial secretions
• Control rhinorrhea of acute rhinitis or hay fever
• Antidote for pilocarpine, physostigmine, isoflurophate, choline esters, certain species of Aminata mushrooms, and anticholinesterase insecticide poisoning
• To lessen the degree of atrioventricular heart block when increased vagal tone is a major factor in the conduction defect, as in some cases due to digitalis

Usual Adult Dose for AV Heart Block

0.4 mg to 0.6 mg, IV, intramuscularly, or subcutaneously

Comments:

• Doses may be considerably exceeded in certain cases.

Uses:

• Treatment of parkinsonism; rigidity and tremor relieved by the apparently selective depressant action
• Relieve pylorospasm, hypertonicity of the small intestine, and hypermotility of the colon
• Relieve hypertonicity of the uterine muscle
• Relax the spasm of biliary and ureter colic and bronchial spasm
• Diminish the tone of the detrusor muscle of the urinary bladder in the treatment of urinary tract disorders
• Control the crying and laughing episode in patients with brain lesions
• Closed head injuries which cause acetylcholine to be released or present in the cerebrospinal fluid, causing abnormal EEG patterns, stupor, and neurological signs
• Management of peptic ulcer
• In anesthesia to control excessive salivation and bronchial secretions
• Control rhinorrhea of acute rhinitis or hay fever
• Antidote for pilocarpine, physostigmine, isoflurophate, choline esters, certain species of Aminata mushrooms, and anticholinesterase insecticide poisoning
• To lessen the degree of atrioventricular heart block when increased vagal tone is a major factor in the conduction defect, as in some cases due to digitalis

Usual Adult Dose for Head Injury

0.4 mg to 0.6 mg, IV, intramuscularly, or subcutaneously

Comments:

• Doses may be considerably exceeded in certain cases.

Uses:

• Treatment of parkinsonism; rigidity and tremor relieved by the apparently selective depressant action
• Relieve pylorospasm, hypertonicity of the small intestine, and hypermotility of the colon
• Relieve hypertonicity of the uterine muscle
• Relax the spasm of biliary and ureter colic and bronchial spasm
• Diminish the tone of the detrusor muscle of the urinary bladder in the treatment of urinary tract disorders
• Control the crying and laughing episode in patients with brain lesions
• Closed head injuries which cause acetylcholine to be released or present in the cerebrospinal fluid, causing abnormal EEG patterns, stupor, and neurological signs
• Management of peptic ulcer
• In anesthesia to control excessive salivation and bronchial secretions
• Control rhinorrhea of acute rhinitis or hay fever
• Antidote for pilocarpine, physostigmine, isoflurophate, choline esters, certain species of Aminata mushrooms, and anticholinesterase insecticide poisoning
• To lessen the degree of atrioventricular heart block when increased vagal tone is a major factor in the conduction defect, as in some cases due to digitalis

Usual Adult Dose for Peptic Ulcer

0.4 mg to 0.6 mg, IV, intramuscularly, or subcutaneously

Comments:

• Doses may be considerably exceeded in certain cases.

Uses:

• Treatment of parkinsonism; rigidity and tremor relieved by the apparently selective depressant action
• Relieve pylorospasm, hypertonicity of the small intestine, and hypermotility of the colon
• Relieve hypertonicity of the uterine muscle
• Relax the spasm of biliary and ureter colic and bronchial spasm
• Diminish the tone of the detrusor muscle of the urinary bladder in the treatment of urinary tract disorders
• Control the crying and laughing episode in patients with brain lesions
• Closed head injuries which cause acetylcholine to be released or present in the cerebrospinal fluid, causing abnormal EEG patterns, stupor, and neurological signs
• Management of peptic ulcer
• In anesthesia to control excessive salivation and bronchial secretions
• Control rhinorrhea of acute rhinitis or hay fever
• Antidote for pilocarpine, physostigmine, isoflurophate, choline esters, certain species of Aminata mushrooms, and anticholinesterase insecticide poisoning
• To lessen the degree of atrioventricular heart block when increased vagal tone is a major factor in the conduction defect, as in some cases due to digitalis

Usual Adult Dose for Organophosphate Poisoning

0.8 mg, IM

• If no apparent effect within 30 minutes OR definite poisoning symptoms occur (nausea, vomiting, diarrhea, pupillary constriction, pulmonary edema, fasciculations of eyelids and tongue, jerky ocular movements and excessive sweating, salivation and bronchial secretion): Give 2 mg, IM, every hour, until signs of atropinization are seen
• The 2 mg dose may need to be given 2 or 3 times (4 to 6 mg total) in severe cases

Auto-injector:
2 or more mild symptoms of exposure: One 2 mg dose
Severe symptoms: One 2 mg dose, followed by two additional 2 mg injections given in rapid succession 10 minutes after the first dose
or
Severe symptoms or unconscious: Three 2 mg doses into the mid-lateral thigh in rapid succession

Mild symptoms:

• Blurred vision, miosis
• Excessive unexplained teary eyes
• Excessive unexplained runny nose
• Increased salivation such as sudden unexplained excessive drooling
• Chest tightness or difficulty breathing
• Tremors throughout the body or muscular twitching
• Nausea and/or vomiting
• Unexplained wheezing or coughing
• Acute onset of stomach cramps
• Tachycardia or bradycardia

Severe symptoms:

• Strange or confused behavior
• Severe difficulty breathing or severe secretions from the lungs/airway
• Severe muscular twitching and general weakness
• Involuntary urination and defecation
• Convulsions
• Unconsciousness

Comments:

• These doses may be considerably exceeded in certain cases.
• Protective garments, including masks, designed specifically for protection against exposure to chemical nerve agents and insecticide poisoning should be worn as primary protection.
• Patients should not rely solely on the availability of antidotes for protection against chemical nerve agent and insecticide poisoning.
• Immediate evacuation from the contaminated environment is essential.
• Decontaminate the poisoned individual as soon as possible.
• The auto-injector should be used by persons with adequate training in recognizing and treating nerve agent or insecticide intoxication.
• Pralidoxime chloride may serve as an important adjunct to atropine therapy.
• The auto-injector is intended as initial treatment of muscarinic symptoms of nerve agent or insecticide poisoning; definitive medical care should be sought immediately.
• Administer as soon as symptoms of poisoning occur (usually tearing, excessive oral secretions, wheezing, muscle fasciculations, etc.).
• In severe poisonings, an anticonvulsant may be concurrently administered if seizure is suspected in the unconscious individual as the classic tonic-clonic jerking may not be apparent due to the effects of the poison.
• It is recommended that 3 auto-injectors be available for each person at risk of nerve agent or organophosphate insecticide poisoning: 1 for mild symptoms, plus 2 more for severe symptoms. Do not administer more than 3 injections unless under supervision of trained medical providers.
• Administering atropine in the absence of actual nerve agent or insecticide poisoning may cause an overdose of atropine which could result in temporary incapacitation (inability to walk properly, see or think clearly for several or more hours); patients with cardiac disease risk severe adverse events, including death.

Uses: Treatment of poisoning by susceptible organophosphorous nerve agents having cholinesterase activity as well as organophosphorous or carbamate insecticides.

Usual Adult Dose for Nerve Agent Poisoning

0.8 mg, IM

• If no apparent effect within 30 minutes OR definite poisoning symptoms occur (nausea, vomiting, diarrhea, pupillary constriction, pulmonary edema, fasciculations of eyelids and tongue, jerky ocular movements and excessive sweating, salivation and bronchial secretion): Give 2 mg, IM, every hour, until signs of atropinization are seen
• The 2 mg dose may need to be given 2 or 3 times (4 to 6 mg total) in severe cases

Auto-injector:
2 or more mild symptoms of exposure: One 2 mg dose
Severe symptoms: One 2 mg dose, followed by two additional 2 mg injections given in rapid succession 10 minutes after the first dose
or
Severe symptoms or unconscious: Three 2 mg doses into the mid-lateral thigh in rapid succession

Mild symptoms:

• Blurred vision, miosis
• Excessive unexplained teary eyes
• Excessive unexplained runny nose
• Increased salivation such as sudden unexplained excessive drooling
• Chest tightness or difficulty breathing
• Tremors throughout the body or muscular twitching
• Nausea and/or vomiting
• Unexplained wheezing or coughing
• Acute onset of stomach cramps
• Tachycardia or bradycardia

Severe symptoms:

• Strange or confused behavior
• Severe difficulty breathing or severe secretions from the lungs/airway
• Severe muscular twitching and general weakness
• Involuntary urination and defecation
• Convulsions
• Unconsciousness

Comments:

• These doses may be considerably exceeded in certain cases.
• Protective garments, including masks, designed specifically for protection against exposure to chemical nerve agents and insecticide poisoning should be worn as primary protection.
• Patients should not rely solely on the availability of antidotes for protection against chemical nerve agent and insecticide poisoning.
• Immediate evacuation from the contaminated environment is essential.
• Decontaminate the poisoned individual as soon as possible.
• The auto-injector should be used by persons with adequate training in recognizing and treating nerve agent or insecticide intoxication.
• Pralidoxime chloride may serve as an important adjunct to atropine therapy.
• The auto-injector is intended as initial treatment of muscarinic symptoms of nerve agent or insecticide poisoning; definitive medical care should be sought immediately.
• Administer as soon as symptoms of poisoning occur (usually tearing, excessive oral secretions, wheezing, muscle fasciculations, etc.).
• In severe poisonings, an anticonvulsant may be concurrently administered if seizure is suspected in the unconscious individual as the classic tonic-clonic jerking may not be apparent due to the effects of the poison.
• It is recommended that 3 auto-injectors be available for each person at risk of nerve agent or organophosphate insecticide poisoning: 1 for mild symptoms, plus 2 more for severe symptoms. Do not administer more than 3 injections unless under supervision of trained medical providers.
• Administering atropine in the absence of actual nerve agent or insecticide poisoning may cause an overdose of atropine which could result in temporary incapacitation (inability to walk properly, see or think clearly for several or more hours); patients with cardiac disease risk severe adverse events, including death.

Uses: Treatment of poisoning by susceptible organophosphorous nerve agents having cholinesterase activity as well as organophosphorous or carbamate insecticides.

Usual Adult Dose for Radiographic Exam

1 mg, IM

Use: Relaxation of the upper gastrointestinal tract and colon during radiography

Usual Pediatric Dose for Anesthesia

7 to 16 pounds: 0.1 mg, IV, IM, or subcutaneously

17 to 24 pounds: 0.15 mg, IV, IM, or subcutaneously

24 to 40 pounds: 0.2 mg, IV, IM, or subcutaneously

40 to 65 pounds: 0.3 mg, IV, IM, or subcutaneously

65 to 90 pounds: 0.4 mg, IV, IM, or subcutaneously

Over 90 pounds: 0.4 to 0.6 mg, IV, IM, or subcutaneously

Comments:

• Doses may be considerably exceeded in certain cases.

Uses:

• Relieve pylorospasm, hypertonicity of the small intestine, and hypermotility of the colon
• Relieve hypertonicity of the uterine muscle
• Relax the spasm of biliary and ureter colic, and bronchial spasm
• Diminish the tone of the detrusor muscle of the urinary bladder in the treatment of urinary tract disorders
• Control the crying and laughing episodes in patients with brain lesions
• Closed head injuries which cause acetylcholine to be released or present in the cerebrospinal fluid, causing abnormal EEG patterns, stupor, and neurological signs
• Management of peptic ulcer
• In anesthesia to control excessive salivation and bronchial secretions
• Control rhinorrhea of acute rhinitis or hay fever
• Antidote for pilocarpine, physostigmine, isoflurophate, choline esters, certain species of Aminata mushrooms, and anticholinesterase insecticide poisoning
• Treatment of parkinsonism; rigidity and tremor relieved by the apparently selective depressant action

Usual Pediatric Dose for Anticholinesterase Poisoning

7 to 16 pounds: 0.1 mg, IV, IM, or subcutaneously

17 to 24 pounds: 0.15 mg, IV, IM, or subcutaneously

24 to 40 pounds: 0.2 mg, IV, IM, or subcutaneously

40 to 65 pounds: 0.3 mg, IV, IM, or subcutaneously

65 to 90 pounds: 0.4 mg, IV, IM, or subcutaneously

Over 90 pounds: 0.4 to 0.6 mg, IV, IM, or subcutaneously

Comments:

• Doses may be considerably exceeded in certain cases.

Uses:

• Relieve pylorospasm, hypertonicity of the small intestine, and hypermotility of the colon
• Relieve hypertonicity of the uterine muscle
• Relax the spasm of biliary and ureter colic, and bronchial spasm
• Diminish the tone of the detrusor muscle of the urinary bladder in the treatment of urinary tract disorders
• Control the crying and laughing episodes in patients with brain lesions
• Closed head injuries which cause acetylcholine to be released or present in the cerebrospinal fluid, causing abnormal EEG patterns, stupor, and neurological signs
• Management of peptic ulcer
• In anesthesia to control excessive salivation and bronchial secretions
• Control rhinorrhea of acute rhinitis or hay fever
• Antidote for pilocarpine, physostigmine, isoflurophate, choline esters, certain species of Aminata mushrooms, and anticholinesterase insecticide poisoning
• Treatment of parkinsonism; rigidity and tremor relieved by the apparently selective depressant action

Usual Pediatric Dose for Bradyarrhythmia

7 to 16 pounds: 0.1 mg, IV, IM, or subcutaneously

17 to 24 pounds: 0.15 mg, IV, IM, or subcutaneously

24 to 40 pounds: 0.2 mg, IV, IM, or subcutaneously

40 to 65 pounds: 0.3 mg, IV, IM, or subcutaneously

65 to 90 pounds: 0.4 mg, IV, IM, or subcutaneously

Over 90 pounds: 0.4 to 0.6 mg, IV, IM, or subcutaneously

Comments:

• Doses may be considerably exceeded in certain cases.

Uses:

• Relieve pylorospasm, hypertonicity of the small intestine, and hypermotility of the colon
• Relieve hypertonicity of the uterine muscle
• Relax the spasm of biliary and ureter colic, and bronchial spasm
• Diminish the tone of the detrusor muscle of the urinary bladder in the treatment of urinary tract disorders
• Control the crying and laughing episodes in patients with brain lesions
• Closed head injuries which cause acetylcholine to be released or present in the cerebrospinal fluid, causing abnormal EEG patterns, stupor, and neurological signs
• Management of peptic ulcer
• In anesthesia to control excessive salivation and bronchial secretions
• Control rhinorrhea of acute rhinitis or hay fever
• Antidote for pilocarpine, physostigmine, isoflurophate, choline esters, certain species of Aminata mushrooms, and anticholinesterase insecticide poisoning
• Treatment of parkinsonism; rigidity and tremor relieved by the apparently selective depressant action

Usual Pediatric Dose for Rhinorrhea

7 to 16 pounds: 0.1 mg, IV, IM, or subcutaneously

17 to 24 pounds: 0.15 mg, IV, IM, or subcutaneously

24 to 40 pounds: 0.2 mg, IV, IM, or subcutaneously

40 to 65 pounds: 0.3 mg, IV, IM, or subcutaneously

65 to 90 pounds: 0.4 mg, IV, IM, or subcutaneously

Over 90 pounds: 0.4 to 0.6 mg, IV, IM, or subcutaneously

Comments:

• Doses may be considerably exceeded in certain cases.

Uses:

• Relieve pylorospasm, hypertonicity of the small intestine, and hypermotility of the colon
• Relieve hypertonicity of the uterine muscle
• Relax the spasm of biliary and ureter colic, and bronchial spasm
• Diminish the tone of the detrusor muscle of the urinary bladder in the treatment of urinary tract disorders
• Control the crying and laughing episodes in patients with brain lesions
• Closed head injuries which cause acetylcholine to be released or present in the cerebrospinal fluid, causing abnormal EEG patterns, stupor, and neurological signs
• Management of peptic ulcer
• In anesthesia to control excessive salivation and bronchial secretions
• Control rhinorrhea of acute rhinitis or hay fever
• Antidote for pilocarpine, physostigmine, isoflurophate, choline esters, certain species of Aminata mushrooms, and anticholinesterase insecticide poisoning
• Treatment of parkinsonism; rigidity and tremor relieved by the apparently selective depressant action

Usual Pediatric Dose for AV Heart Block

7 to 16 pounds: 0.1 mg, IV, IM, or subcutaneously

17 to 24 pounds: 0.15 mg, IV, IM, or subcutaneously

24 to 40 pounds: 0.2 mg, IV, IM, or subcutaneously

40 to 65 pounds: 0.3 mg, IV, IM, or subcutaneously

65 to 90 pounds: 0.4 mg, IV, IM, or subcutaneously

Over 90 pounds: 0.4 to 0.6 mg, IV, IM, or subcutaneously

Comments:

• Doses may be considerably exceeded in certain cases.

Uses:

• Relieve pylorospasm, hypertonicity of the small intestine, and hypermotility of the colon
• Relieve hypertonicity of the uterine muscle
• Relax the spasm of biliary and ureter colic, and bronchial spasm
• Diminish the tone of the detrusor muscle of the urinary bladder in the treatment of urinary tract disorders
• Control the crying and laughing episodes in patients with brain lesions
• Closed head injuries which cause acetylcholine to be released or present in the cerebrospinal fluid, causing abnormal EEG patterns, stupor, and neurological signs
• Management of peptic ulcer
• In anesthesia to control excessive salivation and bronchial secretions
• Control rhinorrhea of acute rhinitis or hay fever
• Antidote for pilocarpine, physostigmine, isoflurophate, choline esters, certain species of Aminata mushrooms, and anticholinesterase insecticide poisoning
• Treatment of parkinsonism; rigidity and tremor relieved by the apparently selective depressant action

Usual Pediatric Dose for Head Injury

7 to 16 pounds: 0.1 mg, IV, IM, or subcutaneously

17 to 24 pounds: 0.15 mg, IV, IM, or subcutaneously

24 to 40 pounds: 0.2 mg, IV, IM, or subcutaneously

40 to 65 pounds: 0.3 mg, IV, IM, or subcutaneously

65 to 90 pounds: 0.4 mg, IV, IM, or subcutaneously

Over 90 pounds: 0.4 to 0.6 mg, IV, IM, or subcutaneously

Comments:

• Doses may be considerably exceeded in certain cases.

Uses:

• Relieve pylorospasm, hypertonicity of the small intestine, and hypermotility of the colon
• Relieve hypertonicity of the uterine muscle
• Relax the spasm of biliary and ureter colic, and bronchial spasm
• Diminish the tone of the detrusor muscle of the urinary bladder in the treatment of urinary tract disorders
• Control the crying and laughing episodes in patients with brain lesions
• Closed head injuries which cause acetylcholine to be released or present in the cerebrospinal fluid, causing abnormal EEG patterns, stupor, and neurological signs
• Management of peptic ulcer
• In anesthesia to control excessive salivation and bronchial secretions
• Control rhinorrhea of acute rhinitis or hay fever
• Antidote for pilocarpine, physostigmine, isoflurophate, choline esters, certain species of Aminata mushrooms, and anticholinesterase insecticide poisoning
• Treatment of parkinsonism; rigidity and tremor relieved by the apparently selective depressant action

Usual Pediatric Dose for Peptic Ulcer

7 to 16 pounds: 0.1 mg, IV, IM, or subcutaneously

17 to 24 pounds: 0.15 mg, IV, IM, or subcutaneously

24 to 40 pounds: 0.2 mg, IV, IM, or subcutaneously

40 to 65 pounds: 0.3 mg, IV, IM, or subcutaneously

65 to 90 pounds: 0.4 mg, IV, IM, or subcutaneously

Over 90 pounds: 0.4 to 0.6 mg, IV, IM, or subcutaneously

Comments:

• Doses may be considerably exceeded in certain cases.

Uses:

• Relieve pylorospasm, hypertonicity of the small intestine, and hypermotility of the colon
• Relieve hypertonicity of the uterine muscle
• Relax the spasm of biliary and ureter colic, and bronchial spasm
• Diminish the tone of the detrusor muscle of the urinary bladder in the treatment of urinary tract disorders
• Control the crying and laughing episodes in patients with brain lesions
• Closed head injuries which cause acetylcholine to be released or present in the cerebrospinal fluid, causing abnormal EEG patterns, stupor, and neurological signs
• Management of peptic ulcer
• In anesthesia to control excessive salivation and bronchial secretions
• Control rhinorrhea of acute rhinitis or hay fever
• Antidote for pilocarpine, physostigmine, isoflurophate, choline esters, certain species of Aminata mushrooms, and anticholinesterase insecticide poisoning
• Treatment of parkinsonism; rigidity and tremor relieved by the apparently selective depressant action

Usual Pediatric Dose for Organophosphate Poisoning

Auto-injector:
Children weighing over 90 pounds: 2 mg dose
40 to 90 pounds: 1 mg dose
15 to 40 pounds: 0.5 mg dose
Less than 15 pounds: 0.25 mg dose (bunch up thigh to provide a thicker area for injection)

2 or more mild symptoms of exposure: One dose (see weight guide above)
Severe symptoms: One dose, followed by two additional doses given in rapid succession 10 minutes after the first dose
or
Severe symptoms or unconscious: Three doses into the mid-lateral thigh in rapid succession

Mild symptoms:

• Blurred vision, miosis
• Excessive unexplained teary eyes
• Excessive unexplained runny nose
• Increased salivation such as sudden unexplained excessive drooling
• Chest tightness or difficulty breathing
• Tremors throughout the body or muscular twitching
• Nausea and/or vomiting
• Unexplained wheezing or coughing
• Acute onset of stomach cramps
• Tachycardia or bradycardia

Severe symptoms:

• Strange or confused behavior
• Severe difficulty breathing or severe secretions from the lungs/airway
• Severe muscular twitching and general weakness
• Involuntary urination and defecation
• Convulsions
• Unconsciousness

Comments:

• These doses may be considerably exceeded in certain cases.
• Protective garments, including masks, designed specifically for protection against exposure to chemical nerve agents and insecticide poisoning should be worn as primary protection.
• Patients should not rely solely on the availability of antidotes for protection against chemical nerve agent and insecticide poisoning.
• Immediate evacuation from the contaminated environment is essential.
• Decontaminate the poisoned individual as soon as possible.
• The auto-injector should be used by persons with adequate training in recognizing and treating nerve agent or insecticide intoxication.
• Pralidoxime chloride may serve as an important adjunct to atropine therapy.
• The auto-injector is intended as initial treatment of muscarinic symptoms of nerve agent or insecticide poisoning; definitive medical care should be sought immediately.
• Administer as soon as symptoms of poisoning occur (usually tearing, excessive oral secretions, wheezing, muscle fasciculations, etc.).
• In severe poisonings, an anticonvulsant may be concurrently administered if seizure is suspected in the unconscious individual as the classic tonic-clonic jerking may not be apparent due to the effects of the poison.
• It is recommended that 3 auto-injectors be available for each person at risk of nerve agent or organophosphate insecticide poisoning: 1 for mild symptoms, plus 2 more for severe symptoms. Do not administer more than 3 injections unless under supervision of trained medical providers.
• Administering atropine in the absence of actual nerve agent or insecticide poisoning may cause an overdose of atropine which could result in temporary incapacitation (inability to walk properly, see or think clearly for several or more hours); patients with cardiac disease risk severe adverse events, including death.

Use: Treatment of poisoning by susceptible organophosphorous nerve agents having cholinesterase activity as well as organophosphorous or carbamate insecticides.

Usual Pediatric Dose for Nerve Agent Poisoning

Auto-injector:
Children weighing over 90 pounds: 2 mg dose
40 to 90 pounds: 1 mg dose
15 to 40 pounds: 0.5 mg dose
Less than 15 pounds: 0.25 mg dose (bunch up thigh to provide a thicker area for injection)

2 or more mild symptoms of exposure: One dose (see weight guide above)
Severe symptoms: One dose, followed by two additional doses given in rapid succession 10 minutes after the first dose
or
Severe symptoms or unconscious: Three doses into the mid-lateral thigh in rapid succession

Mild symptoms:

• Blurred vision, miosis
• Excessive unexplained teary eyes
• Excessive unexplained runny nose
• Increased salivation such as sudden unexplained excessive drooling
• Chest tightness or difficulty breathing
• Tremors throughout the body or muscular twitching
• Nausea and/or vomiting
• Unexplained wheezing or coughing
• Acute onset of stomach cramps
• Tachycardia or bradycardia

Severe symptoms:

• Strange or confused behavior
• Severe difficulty breathing or severe secretions from the lungs/airway
• Severe muscular twitching and general weakness
• Involuntary urination and defecation
• Convulsions
• Unconsciousness

Comments:

• These doses may be considerably exceeded in certain cases.
• Protective garments, including masks, designed specifically for protection against exposure to chemical nerve agents and insecticide poisoning should be worn as primary protection.
• Patients should not rely solely on the availability of antidotes for protection against chemical nerve agent and insecticide poisoning.
• Immediate evacuation from the contaminated environment is essential.
• Decontaminate the poisoned individual as soon as possible.
• The auto-injector should be used by persons with adequate training in recognizing and treating nerve agent or insecticide intoxication.
• Pralidoxime chloride may serve as an important adjunct to atropine therapy.
• The auto-injector is intended as initial treatment of muscarinic symptoms of nerve agent or insecticide poisoning; definitive medical care should be sought immediately.
• Administer as soon as symptoms of poisoning occur (usually tearing, excessive oral secretions, wheezing, muscle fasciculations, etc.).
• In severe poisonings, an anticonvulsant may be concurrently administered if seizure is suspected in the unconscious individual as the classic tonic-clonic jerking may not be apparent due to the effects of the poison.
• It is recommended that 3 auto-injectors be available for each person at risk of nerve agent or organophosphate insecticide poisoning: 1 for mild symptoms, plus 2 more for severe symptoms. Do not administer more than 3 injections unless under supervision of trained medical providers.
• Administering atropine in the absence of actual nerve agent or insecticide poisoning may cause an overdose of atropine which could result in temporary incapacitation (inability to walk properly, see or think clearly for several or more hours); patients with cardiac disease risk severe adverse events, including death.

Use: Treatment of poisoning by susceptible organophosphorous nerve agents having cholinesterase activity as well as organophosphorous or carbamate insecticides.

Renal Dose Adjustments

Data not available

Liver Dose Adjustments

Data not available

Precautions

Caution is recommended when atropine is given to elderly patients because of the increased risk of side effects. The elderly appear to be more prone to the anticholinergic effects of atropine on the CNS, which can result in confusion, agitation, delirium, drowsiness, or coma.

Primary protection against exposure to chemical nerve agent and insecticide poisoning is the wearing of protective garments including masks, designed specifically for this use. Individuals should not reply solely upon the availability of antidotes such as atropine to provide complete protection from chemical nerve agent and insecticide poisoning.

Dialysis

Atropine is not significantly removed by hemodialysis.