Indications & Dose:
Bradycardia due to acute massive overdosage of betablockers
Child: 40 micrograms/kg (max. per dose 3 mg)
Adult: 3 mg
Treatment of poisoning by organophosphorus insecticide or nerve agent (in combination with pralidoxime chloride)
Child: 20 micrograms/kg every 5–10 minutes (max. per dose 2 mg) until the skin becomes flushed and dry, the pupils dilate, and bradycardia is abolished, frequency of administration dependent on the severity of poisoning
Adult: 2 mg every 5–10 minutes until the skin becomes flushed and dry, the pupils dilate, and bradycardia is abolished, frequency of administration dependent on the severity of poisoning
Symptomatic relief of gastro-intestinal disorders
characterised by smooth muscle spasm
Adult: 0.6–1.2 mg daily, dose to be taken at night
Premedication
Child 12–17 years: 300–600 micrograms, to be administered immediately before induction of anaesthesia
Adult: 300–600 micrograms, to be administered immediately before induction of anaesthesia
Child 12–17 years: 300–600 micrograms, to be administered 30–60 minutes before induction of anaesthesia
Adult: 300–600 micrograms, to be administered 30–60 minutes before induction of anaesthesia
Intra-operative bradycardia
Child 12–17 years: 300–600 micrograms, larger doses may be used in emergencies
Adult: 300–600 micrograms, larger doses may be used in emergencies continued
Control of muscarinic side-effects of neostigmine in reversal of competitive neuromuscular block
Child 12–17 years: 0.6–1.2 mg
Adult: 0.6–1.2 mg
Excessive bradycardia associated with betablocker use
Adult: 0.6–2.4 mg in divided doses (max. per dose 600 micrograms)
Bradycardia following myocardial infarction (particularly if complicated by hypotension)
Adult: 500 micrograms every 3–5 minutes; maximum 3 mg per course
Contraindications:
Narrow angle glaucoma, gastric and urinary retention, paralytic ileus. Obstructive disease of GI tract, obstructive uropathy, unstable cardiovascular status, in acute haemorrhage, intestinal atony of the elderly or debilitated patient, thyrotoxicosis, tachycardia, hypersensitivity to belladonna alkaloids.
Side Effects:
Dry mouth with difficulty in swallowing and thirst, dilatation of the pupils with loss of accommodation and sensitivity to light, increased intra-ocular pressure, flushing, dry skin, bradycardia followed by tachycardia, palpitations and arrhythmia, difficulty with micturition and constipation, rarely fever, confusional states and rashes, decreased sweating, constipation, irritation at injection site, increased sensitivity to light, confusion, skin rash, orthostatic hypotension, loss of memory, headache, nausea, vomiting, ventricular fibrillation, palpitation, ataxia.
Cautions:
Elderly, urinary retention, prostatic enlargement, tachycardia, cardiac insufficiency, paralytic ileus, ulcerative colitis and pyloric stenosis; may aggravate gastro-oesophageal reflux; pregnancy and breast-feeding.
Precautions:
In children with spastic paralysis or brain damage. Prostate hypertrophy, congestive heart failure, cardiac arrhythmias, biliary tract disease, chronic lung disease. Heart prostration may occur in hot weather.
Pregnancy: Safety not established.
Breast-feeding: use only if clearly indicated.
Old age: May be used in reduced dose
MONITORING REQUIREMENTS
Control of muscarinic side-effects of neostigmine in reversal of competitive neuromuscular block Since atropine has a shorter duration of action than neostigmine, late unopposed bradycardia may
Interaction:
Drugs
Antihistamines, anti-psychotics, antiparkinsonism medicine, mepridine, orphenadrine, nitrites, alkaline agents, primidone, MAO inhibitors
Warnings:
Adverse Effects:
Lactations:
Special Precautions:
Counselling:
Side Effects Or Adverse Reactions:
Patient And Carer Advice:
© Pakistan Drug Directory. All Rights Reserved.
Designed By: Pakistan Drug Directory Team