What is the maximum recommended dose of atropine in symptomatic bradycardia?

• A. 3 mg
• B. 2 mg
• C. 4 mg
• D. 6 mg

Answer: (A)

Atropine helps restore heart rate in symptomatic bradycardia by blocking vagal (muscarinic) effects on the heart, which increases SA node automaticity and AV nodal conduction. The recommended approach is to give IV atropine in 0.5 mg increments every 3–5 minutes, with a maximum total dose of 3 mg. This ceiling is chosen because higher doses do not provide meaningful additional benefit and raise the risk of anticholinergic toxicity—confusion or delirium, agitation, dry mouth, urinary retention, and potential tachyarrhythmias. If there is no adequate response after reaching the maximum dose, move on to pacing or consider alternative vasopressors and treat reversible causes.