Alternate Name(s):
ESERINE® SALICYLATE, ANTILIRIUM®, ANTICHOLIUM®
Classification:
Parasympathomimetic
Original Date:
August 2005
Revised Date:
March 2023
Indications:
- Treatment of anticholinergic syndrome
Reconstitution and Stability:
- Available as a 0.4 mg/mL injection
- Stable at room temperature
- Protect from light
Compatibility:
- Solutions Compatible: D5W, NS
Administration:
(For approved routes of administration by nursing personnel, refer to Policy for the Administration of Intravenous Medications.)
| SC | NO |
| IM | YES |
| IV Push |
NO |
| IV Intermittent Infusion | YES Usual dilution: undiluted Infusion rate: do not exceed 0.5 mg/min in pediatrics, 1 mg/min in adults |
| IV Continuous Infusion | NO |
Dosage:
(For neonatal dosages, refer to Neonatal IV Drug Manual.)
ANTICHOLINERGIC TOXICITY:
Pediatric:
- 0.01-0.03 mg/kg/dose IV; may repeat after 15-20 minutes to a maximum total dose of 2 mg
Adult:
- 0.5-2 mg IV/IM initially, may repeat Q 20 minutes. May be necessary to use additional doses of 1-4 mg given Q 30-60 minutes as life-threatening signs (arrhythmias, seizures) recur.
Potential hazards of parenteral administration:
- Overdosage can cause cholinergic crisis (symptoms include: salivation, sweating, emesis, miosis, urination, diarrhea, confusion, coma, muscle weakness, paralysis)
- Antidote: mechanical ventilation and atropine
Notes:
- Atropine must be available to reverse excess cholinergic side effects (give 0.5 mg of atropine for every mg of physostigmine)
- Contraindicated in patients with asthma, gangrene, diabetes, cardiovascular diseases, intestinal or urogenital obstruction and patients receiving choline esters or depolarizing muscular blocking agents
- No longer recommended for drug overdose/acute toxicity of medications that possess dose-related anticholinergic properties (ie: tricyclic antidepressants, intrathecal baclofen)
- Caution in patients with epilepsy or bradycardia
- Onset: 3-8 minutes
- Duration: 30 minutes - 5 hours
- Monitor heart rate and respiratory rate