{
  "schema_version": 1,
  "kind": "condition",
  "id": "sinus-bradycardia",
  "name": "Sinus Bradycardia (Symptomatic)",
  "category": "emergency",
  "sources": "ESC Guidelines on cardiac pacing and cardiac resynchronization therapy 2021 · Atropine - StatPearls - NCBI Bookshelf (NBK470551), Administration and Dosing: \"Bradycardia: 1 mg every 3 to 5 minutes (3 mg max), repeat until obtaining desired heart rate\" and \"Pediatric: 0.01 to 0.03 mg/kg every 3 to 5 minutes. The pediatric minimum dose is 0.1 mg, the maximum dose is 0.5 mg (child)\". The 500 microgram lower bound is from Sinus Bradycardia - StatPearls - NCBI Bookshelf (NBK493201): \"the patient can be treated with intravenous (IV) atropine 0.5 mg push every 3 to 5 minutes up to 3 mg total\". · Sinus Bradycardia - StatPearls - NCBI Bookshelf (NBK493201), Treatment / Management",
  "review_status": "reviewed",
  "verified_against": "Atropine - StatPearls - NCBI Bookshelf (NBK470551), Administration and Dosing: \"Bradycardia: 1 mg every 3 to 5 minutes (3 mg max), repeat until obtaining desired heart rate\" and \"Pediatric: 0.01 to 0.03 mg/kg every 3 to 5 minutes. The pediatric minimum dose is 0.1 mg, the maximum dose is 0.5 mg (child)\". The 500 microgram lower bound is from Sinus Bradycardia - StatPearls - NCBI Bookshelf (NBK493201): \"the patient can be treated with intravenous (IV) atropine 0.5 mg push every 3 to 5 minutes up to 3 mg total\". · Sinus Bradycardia - StatPearls - NCBI Bookshelf (NBK493201), Treatment / Management",
  "verified_date": "2026-08",
  "treatments": [
    {
      "id": 1702,
      "generic": "Atropine sulphate",
      "line": 1,
      "is_adjunct": false,
      "form": "injection",
      "strength_mg": 1.0,
      "adult_dose": "500 mcg to 1 mg IV, repeated every 3-5 minutes PRN up to maximum 3 mg for acute symptomatic hemodynamically unstable bradycardia while arranging immediate emergency hospital transfer",
      "adult_duration": "acute emergency single course",
      "dose_source": "Atropine - StatPearls - NCBI Bookshelf (NBK470551), Administration and Dosing: \"Bradycardia: 1 mg every 3 to 5 minutes (3 mg max), repeat until obtaining desired heart rate\" and \"Pediatric: 0.01 to 0.03 mg/kg every 3 to 5 minutes. The pediatric minimum dose is 0.1 mg, the maximum dose is 0.5 mg (child)\". The 500 microgram lower bound is from Sinus Bradycardia - StatPearls - NCBI Bookshelf (NBK493201): \"the patient can be treated with intravenous (IV) atropine 0.5 mg push every 3 to 5 minutes up to 3 mg total\".",
      "rationale": "Atropine is an antimuscarinic that blocks vagal inhibition of the sinoatrial node, raising heart rate in acute hemodynamically unstable bradycardia while emergency transfer is arranged; it treats the acute rhythm, not the underlying cause.",
      "cautions": [
        "Urgent cardiology referral is required if bradycardia is persistent or symptomatic (syncope, dizziness).",
        "Causes tachycardia, dry mouth, urinary retention, and blurred vision.",
        "Identify and treat underlying causes (medications like beta-blockers/diltiazem, hypothyroidism, ischemia).",
        "Children: 0.01 to 0.03 mg/kg."
      ],
      "peds_mgkg_low": 0.02,
      "peds_mgkg_high": 0.02,
      "peds_max_mg": 0.5,
      "peds_basis": "dose",
      "peds_unit": "mg",
      "peds_note": "Minimum dose 0.1 mg to avoid paradoxical bradycardia; emergency pediatric referral",
      "peds_min_weight_kg": null,
      "peds_max_weight_kg": null,
      "peds_age_min_months": null,
      "peds_age_max_months": null,
      "peds_age_bands": null,
      "peds_doses": [
        {
          "weight_kg": 10,
          "low_mg": 0.2,
          "high_mg": 0.2,
          "capped": false
        },
        {
          "weight_kg": 20,
          "low_mg": 0.4,
          "high_mg": 0.4,
          "capped": false
        },
        {
          "weight_kg": 30,
          "low_mg": 0.5,
          "high_mg": 0.5,
          "capped": true
        },
        {
          "weight_kg": 40,
          "low_mg": 0.5,
          "high_mg": 0.5,
          "capped": true
        }
      ],
      "brands": [
        {
          "trade_name": "ATROPINE SULPHATE 1MG/ML 25 AMP. (MISR)",
          "scientific_name": null,
          "normalized_ingredient": null,
          "manufacturer": "MISR",
          "price_egp": 162.5,
          "pack_count": null,
          "unit_price": null,
          "strength_mg": 1.0,
          "exact_strength": true,
          "exact_form": true,
          "discontinued": false,
          "also_contains": null
        },
        {
          "trade_name": "ATROPINE SULPHATE 1MG/ML 100 AMP. (CID)",
          "scientific_name": null,
          "normalized_ingredient": null,
          "manufacturer": "CID",
          "price_egp": 500.0,
          "pack_count": null,
          "unit_price": null,
          "strength_mg": 1.0,
          "exact_strength": true,
          "exact_form": true,
          "discontinued": false,
          "also_contains": null
        },
        {
          "trade_name": "ATROPINE SULFATE 1MG/ML 100 I.V./I.M. AMP. (EL-NILE)",
          "scientific_name": null,
          "normalized_ingredient": null,
          "manufacturer": "EL NILE.",
          "price_egp": 650.0,
          "pack_count": null,
          "unit_price": null,
          "strength_mg": 1.0,
          "exact_strength": true,
          "exact_form": true,
          "discontinued": false,
          "also_contains": null
        }
      ],
      "condition_id": "sinus-bradycardia"
    }
  ]
}