Physostigmine (Antilirium)

Category:

• Nervous system

Description:

• Cholinergic, antiglaucoma agent, miotic

Indications:

• Wide-angle glaucoma (ophth)

• Treatment of anticholinergic toxicity (systemic, including tricyclic antidepressants)

Contraindications:

• Inflammatory disease of iris or ciliary body, newborn, organophosphate poisoning

• Intestinal or urogenital tract obstruction, asthma, diabetes mellitis, patients receiving choline esters or neuromuscular blocking agents (decamethonium, succinylcholine)

Precautions:

• Pregnancy category C

• Epilepsy, parkinsonism

• Bradycardia, bronchitis, cardiovascular disease

Adverse Reactions (Side Effects):

• CNS: anxiety, delirium, disorientation, hallucinations, headache, hyperactivity, seizures

• CV: bradycardia, hypertension, hypotension, irregular pulse

• EENT: blurred vision, conjunctivitis, decreased secretions in pharynx, lacrimation

• GI: abdominal cramps, diarrhea, nausea, vomiting

• RESP: bronchospasm, decreased bronchial secretions, dyspnea, pulmonary edema

• MISC: hyperpyrexia  

Dosage:

Administered intravenously, intramuscularly, topically (ophth)

• Adult:            

  • Glaucoma: 

    • Instill ointment ¼ inch strip of 0.25% ointment in conjunctival sac 1-3 times daily

    • Instill solution 1 drop of a 0.25%-0.5% solution in conjunctival sac 1-4 times daily

  • Anticholinergic toxicity: 

    • IM/IV 0.5-2mg given at a rate not greater than 1 mg/min; repeat every 20-30 minutes; max single dose 4mg, as needed

• Child:            

  • Glaucoma: 

    • See adult

  • Anticholinergic toxicity: 

    • IV 0.2mg (20 mcg)/kg over at least 1 minute; may repeat every 5-10 minutes; max dose 2mg