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Important Administration Information Three (3) Atropine autoinjectors should be available for use in each patient at risk for nerve agent or organophosphate insecticide poisoning; one (1) for mild symptoms plus two (2) more for severe symptoms [see Dosage and Administration (2.2)]. Only administer Atropine to patients experiencing symptoms of organophosphorus poisoning in a situation where exposure is known or suspected. The Atropine autoinjector is intended as an initial treatment of the muscarinic symptoms of insecticide or nerve agent poisonings as soon as symptoms appear; definitive medical care should be sought immediately. In general, atropine should not be used until cyanosis has been overcome since atropine may produce ventricular fibrillation and possible seizures in the presence of hypoxia. The Atropine autoinjector should be used by persons who have had adequate training in the recognition and treatment of nerve agent or insecticide intoxication, but may be administered by a caregiver or by self-administration if a trained provider is not available. Close supervision of all treated patients is indicated for at least 48 to 72 hours. In severe poisonings, concurrent administration of an anticonvulsant (preferably a benzodiazepine) may be warranted if seizure is suspected in the unconscious individual because overt jerking may not be apparent because of the effects of the poison [see Drug Interactions (7.2)]. In poisonings caused by organophosphorous nerve agents and insecticides it may also be helpful to concurrently administer a cholinesterase reactivator such as pralidoxime chloride [see Drug Interactions (7.1)]. The injection site is the mid-lateral thigh area. The Atropine autoinjector can inject through clothing. However, make sure pockets at the injection site are empty. People who may not have a lot of fat at the injection site should also be injected in the mid-lateral thigh, but before giving the injection, bunch up the thigh to provide a thicker area for injection. Dosage Information Dosage for Mild Symptoms in Adults and Pediatric Patients Weighing More Than 41 kg (90 Pounds) First Dose: If the patient experiences two or more mild symptoms of nerve agent (nerve gas) or insecticide exposure listed in Table 1, administer one (1) Atropine injection intramuscularly into the mid-lateral outer thigh. Additional Doses: If, at any time after the first dose, the patient develops any of the severe symptoms listed in Table 1, administer two (2) additional Atropine injections intramuscularly in rapid succession. Wait 10 to 15 minutes for Atropine to take effect. If, after 10 to 15 minutes, the patient does not develop any of the severe symptoms listed in Table 1, no additional Atropine injections are recommended. If possible, a person other than the patient should administer the second and third 2 mg Atropine autoinjectors. Dosage for Severe Symptoms in Adults and Pediatric Patients Weighing More Than 41 kg (90 Pounds) If a patient is either unconscious or has any of the severe symptoms listed in Table 1, immediately administer three (3) Atropine injections intramuscularly into the patient’s mid-lateral outer thigh in rapid succession. Table 1: Common Signs/Symptoms of Organophosphorus and/or Carbamate Poisoning MILD symptoms include: Blurred vision or miosis Unexplained excessive lacrimation Unexplained excessive nasopharyngeal secretions Increased salivation Chest tightness, difficulty breathing, wheezing, or coughing Tremors throughout the body or muscular twitching Nausea, vomiting, abdominal cramping, or diarrhea Tachycardia or bradycardia SEVERE symptoms include: Altered mental status Loss of consciousness Respiratory distress Excessive secretions from the lungs/airway Severe muscular twitching, generalized weakness or paralysis Involuntary urination and/or defecation Convulsions or seizures Additional Care Instructions Environmental All patients should be evacuated immediately from the contaminated environment. Protective masks and clothing should be used when available. Aggressive and safe decontamination procedures should be undertaken as soon as possible. If dermal exposure has occurred, clothing should be removed and the hair and skin washed thoroughly with sodium bicarbonate or alcohol as soon as possible. Physicians and/or other medical personnel assisting evacuated patients of nerve and insecticide poisoning should avoid exposing themselves to contamination by the patient’s clothing. Medical Medical help should be sought immediately. Emergency care of the severely poisoned individual should include removal of oral and bronchial secretions, maintenance of a patent airway, supplemental oxygen and, if necessary, artificial ventilation. Severe difficulty in breathing requires artificial respiration in addition to the use of Atropine since Atropine is not dependable in reversing the weakness or paralysis of the respiratory muscles. Refer to the illustrated dose-specific Instructions for Use for autoinjector administration instructions. Antidotes, such as Atropine, should not be relied upon solely to provide complete protection from chemical nerve agents and insecticide poisoning. Atropine is intended as an initial treatment as soon as symptoms appear; definitive medical care should be sought immediately. (2.1) Administer each dose of the 2 mg Atropine autoinjector into the patient’s mid-lateral outer thigh (2.1). Dosage for Mild Symptoms : If the patient experiences two or more mild symptoms, administer one injection intramuscularly into the mid-lateral thigh. If, at any time after the first dose, the patient develops any of the severe symptoms, administer two additional injections intramuscularly in rapid succession (2.2). Dosage for Severe Symptoms : If a patient has any of the severe symptoms, immediately administer three injections intramuscularly into the patient's mid-lateral thigh in rapid succession (2.2).

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Atropine is indicated for the treatment of poisoning by susceptible organophosphorus nerve agents having anticholinesterase activity as well as organophosphorus or carbamate insecticides in adults and pediatric patients weighing more than 41 kg (90 pounds).