Background: Spinal anesthesia induced hypotension is common and dangerous especially in the elderly, as they have diminished physiological reserve and compromised blood supply to the vital organs. Aim: To compare the heart rate, systolic and diastolic blood pressure after spinal anesthesia with prophylactic use of atropine and ephedrine. Materials and Methods: This was a prospective study in which sixty ASA I and II patients undergoing urological surgeries were assigned to receive I.V. atropine 0.6 mg or I.V. ephedrine 12 mg one minute after spinal anesthesia induction. Heart Rate (HR), systolic and diastolic blood pressure, requirement of mephentermine and phenylephrine and side effects were studied. Hemodynamic parameters were compared with baseline values among the groups. Results: The patients with demographic data, baseline hemodynamic parameters and duration of surgery were comparable in both groups. Compared to baseline, trend of mean HR, systolic and diastolic BP were significantly less in Group E (ephedrine) than Group A (atropine). Conclusion: Administration of intravenous atropine 0.6 mg one min after induction of spinal anesthesia in elderly patients is safe and effective in the prevention of spinal anesthesia induced hypotension and bradycardia. Also, the requirement of vasopressors decreases without clinically significant side effects.