Liverpool Hospital Emergency Department
- Severe Anticholinergic Toxidrome caused by a pure anticholinergic drug under clinical advice from a toxicologist
- Short acting IV cholinesterase inhibitor that crosses the BBB.
- Intravenous 2mg (5ml)
Dosage and Administration:
- Administer in a resuscitation area: risk of bradydysrhythmias / bronchospasm
- 0.5mg (0.01mg/kg up to 0.5mg) IV over 5 minutes and repeat after 15 minutes if there is no response to a maximum of 2mg in a 60-minute period
- Avoid in patients with bradycardia and bronchospasm
- Response: Resolution of the delirium
- Nausea / Vomiting / Diarrhoea
- Avoid in TCA overdose or non-pure anticholinergic overdose as serious adverse effects have occurred including seizures and arrhythmias.
- Redosing may be required as physostigmine is short-acting (1-2 hours)
- Consider alternative agents for control of agitation if physostigmine is not available including benzodiazepines and droperidol.
- Large doses of these agents might be required.