Adult Dosing

Post-anesthesia Care

• 0.5-1 mg IM/IV; rate of IV administration should be 1 mg/minute
• Repeat dose q10-30 minutes, if adequate response is not observed

Anticholinergic toxicity

• 2 mg IM/IV; rate of IV administration should be 1 mg/minute
• Repeat dose, if life-threatening symptoms such as arrhythmia, convulsions or coma occur

Note:

• Provide appropriate supportive measures in all cases of poisoning
• Keep appropriate antidote, such as atropine sulfate, readily available to manage a possible cholinergic crisis

Pediatric Dosing

Anticholinergic toxicity

• 0.02 mg/kg IM/IV; rate of IV administration should be 0.5 mg/minute
• If toxic effects persist or there is no sign of cholinergic effects, repeat dose at intervals of 5-10 minutes until therapeutic effect is achieved or a maximum of 2 mg dose is attained

Note:

• Provide appropriate supportive measures in all cases of poisoning
• Keep appropriate antidote, such as atropine sulfate, readily available to manage a possible cholinergic crisis

• To reverse the neurological effects of drugs capable of causing anticholinergic syndrome with clinical or toxic doses

• Hypersensitivity to any of the ingredients of the product
• Hypersensitivity to sulfites
• Asthma
• Gangrene
• Diabetes mellitus
• Cardiovascular disease
• Arrhythmias
• Angle-closure glaucoma
• Intestinal obstruction
• Urogenital tract obstruction
• Vagotonic state
• Concomitant use of choline esters
• Co-administration of depolarizing neuromuscular blockers (decamethonium, succinylcholine)
• Concomitant use of atropine (for post-anesthesia)
• Neonates

• N/A

Renal Dose Adjustment

• Renal impairment: Dose adjustments not defined

Hepatic Dose Adjustment

• Hepatic impairment: Dose adjustments not defined

• The product contains sodium bisulfite, a sulfite that may cause allergic-type reactions including anaphylactic symptoms and life-threatening asthmatic episodes in susceptible individuals, particularly in asthmatic people
• Discontinue therapy if excessive symptoms of salivation, emesis, urination and defecation occur. Consider dose reduction in case of excessive nausea or sweating
• For IV use, ensure administration at a slow, controlled rate (1 mg/minute). Rapid administration may result in bradycardia, hypersalivation leading to respiratory difficulties and convulsions
• A cholinergic crisis may occur as a result of overdosage of physostigmine injection
• Atropine sulfate, an antagonist and antidote for physostigmine, should be readily available to manage any possible hypersensitivity reactions

Cautions: Use cautiously in

• Bradycardia
• Seizure disorder
• Increased vagal tone
• Hypotension
• Peptic ulcer disease
• GERD
• Hyperthyroidism

Pregnancy Category:C

Breastfeeding: Safety unknown. Manufacturer advises considering risk-benefit analysis before administering to nursing women.

• CV: Bradycardia, severe hypotension, palpitations, AV block, arrhythmias, cardiac arrest
• CNS: Convulsions, dizziness, restlessness, hallucinations, CNS stimulation, syncope, paralysis, headache
• GI: Nausea, vomiting, hypersalivation, abdominal bloating/cramps, diarrhea, flatulence
• GU: Urinary frequency or urgency
• EENT: Increased lacrimation, miosis, blurred vision, rhinorrhea
• RESP: Bronchospasm, respiratory depression, respiratory arrest, respiratory paralysis, increased pulmonary secretions, pulmonary edema, dyspnea
• MUSC: Muscle twitching, muscle weakness, fasciculations
• MISC: Anaphylaxis, cholinergic crisis, diaphoresis

• Cholinesterase inhibitors; inhibits the destructive action of acetylcholinesterase, which increases the concentration of acetylcholine at the sites of cholinergic transmission, thereby prolonging the effect of acetylcholine at cholinergic synapses
• Readily absorbed from IM sites
• Quickly hydrolyzed by tissue/plasma cholinesterases
• Excreted in urine minimally
• Half-life: 15-40 min

US Trade Name(s)

• Only generic available

US Availability

physostigmine (generic)

• INJ: 1 mg/mL (2 mL ampoules)

Canadian Trade Name(s)

• N/A

Canadian Availability

• N/A

UK Trade Name(s)

• N/A

UK Availability

• N/A

Australian Trade Name(s)

• N/A

Australian Availability

• N/A

Toxicology

Antidotes

Acetylcholinesterase Inhibitors

Anesthesia

Antidotes

Acetylcholinesterase Inhibitors