Parasympatholytic
0.5 or 1 mg/ml depending on the manufacturer.
Preparation: 0.5 mg/ml · 1 mg/ml
Symptomatic bradycardia – adults
- 0.5 mg i.v./i.o.[1]every 3–5 min up to max. 3 mg in total · 0.5 mg/ml · = 1 ml
If ineffective – adrenaline or isoprenaline via syringe driver, or pacing (transcutaneous as a bridge to transvenous pacing). No atropine after heart transplantation – may cause high-grade AV block or even sinus arrest (give aminophylline instead). No atropine in high-grade AV block with broad QRS – ineffective, may worsen the block.
Contraindications
- No absolute contraindications in the emergency indication.
Notes
- Angle-closure glaucoma, tachyarrhythmia, myocardial ischaemia – weigh benefit/risk.
- Doses < 0.5 mg (adults) may cause paradoxical bradycardia.
- Children – according to the Austrian SmPC of an atropine sulfate product (as of 06/2026) for bradycardia 0.02 mg/kg i.v. or i.o., minimum dose 0.1 mg, maximum single dose 0.5 mg (adolescents 1 mg) – as in ERC 2025 (children) 20 µg/kg, max. 0.5 mg. Reversal of neuromuscular blocking agents according to this SmPC 0.02 mg/kg, at most 0.6 mg.
- Organophosphate poisoning (organophosphorus esters) requires much higher doses – according to the Austrian package leaflet of the same atropine sulfate product 2–4 mg i.m., i.v. in severe cases. Children – according to the Austrian SmPC (as of 06/2026) 0.05 mg/kg i.v. or i.m., repeat every 10–30 min until symptoms subside – consult the poisons information centre (see Toxicology).