📋 Indications & Clinical Dosage
*Symptomatic relief of gastro-intestinal disorders
characterized by smooth muscle spasm:*
Adult: 0.6-1.2 mg daily, dose to be taken at night.
PREMEDICATION:
BY IV INJ: Adults & Children above 12yrs: 300-600 mcg, to be administered immediately before induction of anaesthesia
BY SC INJ, OR BY IM INJ: Adults & Children above 12yrs:
300-600 mcg, to be administered 30-60 minutes before induction of anaesthesia
*Intra-operative bradycardia:*
BY IVINJ: Adults & Children above 12yrs: 300-600 mcg, larger doses may be used in emergencies.
*Bradycardia due to acute massive over-dosage of beta-blockers:*
BY IV INJ: Adult: 3 mg
Children: 40 mcg/kg (max. per dose 3 mg)
*Treatment of poisoning by organophosphorus
Insecticide or nerve agent (in combination with
Pralidoxime chloride):*
BY IV INJ: Adult: 2 mg every 5-10 minutes until the skin becomes flushed and dry, the pupils dilate, and bradycardia is abolished, frequency of administration dependent on the severity of poisoning.
Children: 20 mcg/kg every 5-10 minutes (max. per dose 2 mg) until the skin becomes flushed and dry, the pupils dilate, and bradycardia is abolished, frequency of administration dependent on the severity ofpoisoning
*Control of muscarinic side-effects of neostigmine in reversal of competitive neuromuscular block:*
BY IV INJ: Adults & Children above 12 yrs: 0.6-1.2 mg
*Excessive bradycardia associated with beta-blocker use:*
BY IV INJ: Adult: 0.6-2.4 mg in divided doses (max. per dose
600 mcg)
*Bradycardia following myocardial infarction (complicated by hypotension):*
BY IV INJ: Adult: 500 mcg every 3-5 minutes; max. 3 mg per course
⛔ Contraindications
Hypersensitivity to atropine, tachycardia,
thyrotoxicosis narrow angle glaucoma, obstructive disease of the GI tract, obstructive uropathy, prostatic hypertrophy, unstable cardiac rhythm.
⚠️ Precautions & Warnings
Antimuscarinics drugs used for premedication to
general anaesthesia should only be administered by, or under professional supervision.Use with caution in children with spastic paralysis or brain damage.
🔄 Drug Interactions
Anticholinergic agents may alter response to beta-adrenergic blockers.
⚠️ Adverse Reactions / Side Effects
Cardiac arrhythmia, atrioventricular dissociation, multiple ventricular ectopics, tachycardia, palpitations, hallucinations, confusion, drowsiness, fatigue,restlessness, ataxia delirium, headache, dry hot skin, thirst, dry mouth, impaired GI motility, tremor, blurred vision.
🤰 Pregnancy & Lactation Safety
Pregnancy Risk:
Caution advised.
Lactation / Breastfeeding:
Caution advised. May suppress lactation; small amount present in milk.
🧪 Compatibility & Storage Stability
Compatibility: Incompatible with thiopental (Y-site administration),
cimetidine/pentobarbital (in syringe), Compatibility when admixed: Incompatible with floxacillin, metaraminol, methohexital, norepinephrine.
Stability & Storage: Store injection at controlled room temperature of 15C-30C. Protect from light.
📚 Official Regulatory & Clinical References
- Drug Regulatory Authority of Pakistan (DRAP): Drug Registration, S.R.O. Price Gazettes & National Essential Medicines List (NEML).
- World Health Organization (WHO): Collaborating Centre for Drug Statistics Methodology (ATC/DDD Index).
- Formulary Standards: British National Formulary (BNF) & Pakistan National Formulary (PNF) guidelines.