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    DEA Class;  Rx

    Common Brand Names; 

    • Acetylcholinesterase Inhibitors, Peripheral; 
    • Anticholinergic Toxicity Antidotes

    Indirect acting parasympathomimetic via inhibition of acetylcholinesterase

    For the Anticholinergic Toxicity

    Rarely used; indicated only when life-threatening symptoms related to anticholinergic toxicity

    Useful for diagnostic as opposed to therapeutic reasons

    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


    Cardiovascular collapse







    Cholinergic Sx


    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 Category: C

    Lacation: Unknown if excreted in breast milk; caution advised


    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


    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

    Injectable solution

    • 1mg/mL