Classes
DEA Class; Rx
Common Brand Names;
- Acetylcholinesterase Inhibitors, Peripheral;
- Anticholinergic Toxicity Antidotes
Description
Indirect acting parasympathomimetic via inhibition of acetylcholinesterase
Indications
For the Anticholinergic Toxicity
Rarely used; indicated only when life-threatening symptoms related to anticholinergic toxicity
Useful for diagnostic as opposed to therapeutic reasons
Contraindications
Salicylate allergy
Asthma, gangrene, diabetes, cardiovascular disease, mechanical obstruction of the intestinal or urogenital tract or any vagotonic state
Concurrency with choline esters or depolarizing neuromuscular blocking agents
Adverse Effects
Seizure
Cardiovascular collapse
Bradycardia
Bronchospasm
Dyspnea
Diaphoresis
Diarrhea
Hyperperistalsis
Cholinergic Sx
Hallucinations
Warnings
Overdosage may result in cholinergic crisis (eg, excessive salivation and sweating, miosis, nausea, vomiting, diarrhea, bradycardia or tachycardia, hypotension or hypertension, confusion, seizures, coma, severe muscle weakness, paralysis); if overdosage occurs, mechanical ventilation with repeated bronchial aspiration and IV atropine are recommended
Possible bradycardia, hypersalivation leading to respiratory problems, and/or seizures associated with rapid IV administration; asystole also has been reported; administer at a slow controlled rate
Discontinue therapy if excessive salivation, vomiting, urination, or defecation occurs; reduce dosage if excessive sweating or nausea occurs; atropine sulfate injection should always be readily available; observe patient for evidence of bronchial constriction; perform cardiac monitoring
Use with caution in patients with epilepsy, parkinsonian syndrome, or bradycardia
Pregnancy and Lactation
Pregnancy Category: C
Lacation: Unknown if excreted in breast milk; caution advised
Maximum Dosage
Initial: 0.5-2 mg slow IVP (not to exceed 1 mg/min); keep atropine nearby for immediate use
If no response, repeat q20min PRN
If initial dose effective, may give additional 1-4 mg q30-60min PRN
Pediatric
0.02 mg/kg/dose slow IVP (not to exceed 0.5 mg/min); may repeat q5-10min PRN, not to exceed cumulative dose of 2 mg
