Pre-anaesth medication in conjugation w/ morphine sulphate. Reverse effects of non-depolarising muscle relaxants in conjugation w/ neostigmine methyl sulphate. Smooth muscle spasm in conditions eg, renal & biliary colic. Management of arrhythmias & treatment of bradycardia or asystole due to overdosage w/ parasympathomimetic agents. Suppression of GI motility in the treatment of peptic ulcer. Diagnosis of colicky pain. Antidote in carbamate & w/ pralidoxime in organophosphorus insecticide poisoning.
Dosage/Direction for Use
IVManagement of arrhythmias 400 mcg-1 mg, repeat as needed to total dose: 2 mg. SC/IM/IVBradycardia or asystole due to overdosage w/ parasympathomimetic agents 1-2 mg. IV/IMAnticholinesterase poisoning Initially 1-2 mg for mild poisoning; 6 mg as often as every 5 min for severe poisoning. SC/IM/IV Adult GI anticholinergic effect 400-600 mcg qds. Pre-anaesth medication 300-600 mcg 1 hr before induction. SCChildn 10 mcg/kg every 4-6 hr; reduce dose on hot days or for febrile childn.
Contraindications
Closed-angle glaucoma, gastric or duodenal ulcer causing stenosis & significant gastric retention, urinary retention in prostatic hypertrophy, paralytic ileus, debilitated patients w/ oesophageal reflux or oesophagitis. Situations where ambient temp is high since hyperpyrexia may follow, especially in childn. Patients w/ myasthenia gravis unless to reduce adverse muscarinic effects. Lactation.
Special Precautions
Tachycardia eg, thyrotoxicosis, cardiac insufficiency or failure & in cardiac surgery. HTN, fever, diarrhoea, acute MI. Childn. Elderly.
Adverse Reactions
Mouth dryness w/ difficulty in swallowing, thirst, dilated pupils w/ accommodation loss & photophobia, increased IOP, flushing & skin dryness, bradycardia followed by tachycardia w/ palpitations & arrhythmias, urinary retention, constipation, occasional vomiting, giddiness, staggering. Rapid & stertorous respiration, hyperpyrexia, restlessness, confusion, excitement, hallucinations passing into delirium, rash (may appear on face & upper trunk).
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