Physostigmine Salicylate and Asthma

• Generic Name: physostigmine
• Dosage Forms: n.a.
• Other Brand Names: Antilirium

Carefully weigh risks and potential benefits of physostigmine therapy when making individual decisions about its use since serious adverse effects (including seizures and asystole) may occur with physostigmine therapy.

The manufacturers state that physostigmine is used to reverse CNS effects resulting from clinical or toxic dosages of drugs (e.g., some antihistamines, antimuscarinics, antiparkinsonian agents, phenothiazines) capable of producing anticholinergic syndrome and from intoxication with certain plants (e.g., Atropa belladonna [deadly nightshade], Brugmansia species [angels’ trumpet], Datura stramonium [jimsonweed, thorn apple, locoweed], Lantana camara). However, routine use not recommended because of potentially serious adverse effects (e.g., seizures, bronchospasm, bradycardia, asystole); many clinicians advise to reserve use for treatment of severe or life-threatening symptoms (e.g., extensive delirium or agitation, hallucinations, hyperthermia, severe sinus or supraventricular tachycardia, seizures) in patients who fail to respond to alternative therapy.

Has also been used successfully in the treatment of tricyclic antidepressant-induced anticholinergic toxicity, but currently is rarely used because of potentially serious adverse effects (seizures, bronchospasm, bradycardia, asystole). Precise role controversial; most clinicians advise against the routine use of physostigmine in tricyclic intoxication, and some clinicians recommend to reserve use only for life-threatening anticholinergic symptoms refractory to other treatment.

Treatment to reverse anticholinergic effects (e.g., delirium, prolonged somnolence) produced by atropine and/or scopolamine preanesthetic medications.

Has been used with variable results in the treatment of dementia of the Alzheimer’s type (Alzheimer’s disease), alone or combined with lecithin.

Has been used for the treatment of Friedreich’s ataxia and other hereditary ataxias (spinocerebellar degenerations) (designated an orphan drug by FDA for these uses).