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Physostigmine (Physostigmine Salicylate) - Warnings and Precautions



Contains sodium bisulfite, a sulfite that may cause allergic-type reactions including anaphylactic symptoms and life-threatening or less severe asthmatic episodes in certain susceptible people. The overall prevalence of sulfite sensitivity in the general population is unknown and probably low. Sulfite sensitivity is seen more frequently in asthmatic than in non-asthmatic people.

If excessive symptoms of salivation, emesis, urination and defecation occur, the use of Physostigmine Salicylate Injection should be terminated. If excessive sweating or nausea occur, the dosage should be reduced.

Intravenous administration should be at a slow, controlled rate, no more than 1 mg per minute (see dosage). Rapid administration can cause bradycardia, hypersalivation leading to a respiratory difficulties and possible convulsions.

An overdosage of Physostigmine Salicylate Injection can cause a cholinergic crisis.


Because of the possibility of hypersensitivity in an occasional patient, atropine sulfate injection should always be at hand since it is an antagonist and antidote for physostigmine.


Safe use in pregnancy and lactation has not been established; therefore, use in pregnant women, nursing mothers or women who may become pregnant requires that possible benefits be weighed against possible hazards to mother and child.

Page last updated: 2010-11-15

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