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

 

 

 

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Approved for public release; Distribution is unlimited.

The information contained here is an abbreviated summary. For more detailed and complete information, consult the manufacturer's product information sheets or standard textbooks.

Source: Operational Medicine 2001, Health Care in Military Settings, NAVMED P-5139, May 1, 2001, Bureau of Medicine and Surgery, Department of the Navy, 2300 E Street NW, Washington, D.C., 20372-5300.

Bureau of Medicine and Surgery
Department of the Navy
2300 E Street NW
Washington, D.C
20372-5300

Operational Medicine
 Health Care in Military Settings
CAPT Michael John Hughey, MC, USNR
NAVMED P-5139
  January 1, 2001

United States Special Operations Command
7701 Tampa Point Blvd.
MacDill AFB, Florida
33621-5323

*This web version is provided by The Brookside Associates, LLC.  It contains original contents from the official US Navy NAVMED P-5139, but has been reformatted for web access and includes advertising and links that were not present in the original version. The medical information presented was reviewed and felt to be accurate in 2001. Medical knowledge and practice methods may have changed since that time. Some links may no longer be active. This web version has not been approved by the Department of the Navy or the Department of Defense. The presence of any advertising on these pages does not constitute an endorsement of that product or service by either the US Department of Defense or the Brookside Associates. The Brookside Associates is a private organization, not affiliated with the United States Department of Defense.

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