Category:

• Nervous system

Description:

• Anticholinergic, antispasmotic, antiasthmatic, bronchodilator, mydriatic

Indications:

• Bradycardia, bradydysrhythmia, anticholinesterase insecticide poisoning

• Blockade of cardiac vagal refleses, antisialagogue, rigidity/tremor of parkinsonism

• Antispasmotic with GU and biliary surgery, bronchodilator

• Mydriasis/cycloplegia for iritis, cycloplegic refraction

Contraindications:

• Hypersensitivity to belladonna alkaloids, angle-closure glaucoma, GI obstruction

• Myasthenia gravis, ulcerative colitis, prostatic hypertrophy, tachydysrhythmias, asthma, acute hemorrhage, myocardial ischemia

Precautions:

• Pregnancy category C

• Renal disease, lactation, CHF, hyperthyroidism, COPD, hepatic disease, child <6 years

• Hypertension, elderly, intraabdominal infections, Down syndrome, spastic paralysis

• Gastric ulcer

Adverse Reactions (Side Effects):

• CNS: anxiety, coma, confusion, dizziness, flushing, headache, involuntary movement, psychosis, weakness

• CV: angina, ectopic ventricular beats, hypertension, hypotension, PVC’s, paradoxical bradycardia, tachycardia

• EENT: blurred vision, eye pain, glaucoma, nasal congestion, photophobia, pupil dilation

• GI: abdominal distension, abdominal pain, altered taste, anorexia, constipation, dry mouth, nausea, paralytic ileus, vomiting

• GU: dysuria, hesitancy, impotence, retention

• SKIN: contact dermatitis, dry skin, flushing, rash, urticaria

• MISC: decreased sweating, suppression of lactation

Dosage:

Administered topically, intramuscularly, intravenously, subcutaneously

• Adult:

  • Bradycardia/bradydysrhythmias: 

    • IV bolus 0.5-1mg given every 3-5 minutes

    • not to exceed 2mg

  • Insecticide poisoning: 

    • IM/IV 2mg every hour until muscarinic symptoms disappear

    • may need 6mg every hour

  • Pre-surgery: 

    • SC/IM/IV 0.4-0.6mg before anesthesia

  • Iritis/cycloplegic refraction: 

    • Instill solution 1-2 drops of 1% solution 1-3 times daily for iritis or 1 hour before refracting

• Child:             

  • Bradycardia/bradydysrhythmias: 

    • IV bolus 0.01-0.03 mg/kg up to 0.4 mg or 0.3 mg per meter square

    • may repeat every 4-6 hours

  • Insecticide poisoning: 

    • IM/IV 2mg hourly until muscarinic symptoms disappear

    • may need 6mg hourly

  • Pre-surgery: 

    • SC 0.1-0.4mg 30 minutes before surgery

•             Iritis/cycloplegic refraction: Instill 1-2 drops of a 0.5% solution 1-3 times daily for iritis or twice daily 1-3 days before exam; instill ointment 1-2 times daily 2-3 days before exam