Physostigmine (Antilirium)


  • Nervous system


  • Cholinergic, antiglaucoma agent, miotic


  • Wide-angle glaucoma (ophth)

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


  • 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)


  • 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  


Administered intravenously, intramuscularly, topically (ophth)

  • Adult:            

    • Glaucoma: 

      • Instill ointment 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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