Physostigmine (Eserine)

Alzheimer's dementia
Adult: Initial dose: 0.5 mg every 2 hr, 6 or 7 times daily until beneficial or adverse effects occur. Max dose: 16 mg/day.
Reversal of anticholinergic effect
Adult: Initial dose: 0.5-2 mg. May be given via slow IV inj or IM, repeated every 20 min until response or adverse effects occur. If initial doses are effective, additional doses of 1-4 mg may be given as necessary at usual intervals of 30-60 minutes as life-threatening signs recur.
Child: For life-threatening situations only: 0.02 mg/kg as initial dose. May be given via slow IV inj or IM, repeated at 5-10 min intervals until response or adverse effects occur or a total dose of 2 mg has been admin.
Stimulate peristalsis in postoperative intestinal atony
Adult: Usual dose: 0.5-2 mg IV or IM inj.
Adult: As sulfate, 0.25% ointment. As salicylate, 0.25% or 0.5% eye drops.
Acute iritis; acute uveitis; anterior uveitis; some forms of secondary glaucoma.
Warnings / Precautions
Acute inflammatory disease of the anterior segment of the eye. Discontinue before eye surgery (risk of hyphema). History of retinal detachment, children with myopia. Night driving or hazardous task undertaken in poor illumination. Patients wearing soft contact lenses. Prolonged use may lead to depigmentation of the lid margins in dark-skinned patients.
Adverse Reactions
Systemic: CNS effects, may produce follicles in the conjunctiva, increased salivation, nausea, vomiting, abdominal cramps, diarrhoea, allergic reactions. Ophthalmic: Ciliary spasm, ocular pain and irritation, blurred vision, lachrymation, myopia, browache, conjunctival vascular congestion, superficial keratitis, vitreous haemorrhage, increased pupillary block, lens opacities (prolonged use).
Potentially Fatal: Respiratory failure.
Overdose Reactions
May lead to "cholinergic crisis" which include excessive sweating, lachrymation, increased peristalsis, bradycardia and bronchospasm.
Drug Interactions
Aminoglycosides, clindamycin, colistin, cyclopropane, halogenated inhalational anaesthetics and atropine may antagonise the effects of physotigmine. Quinine, chloroquine, hydroxychloroquine, quinidine, procainamide, propafenone, lithium and β-blockers may reduce treatment efficacy. Prolonged bradycardia may occur when taken with β-blockers. May prolong the action of suxamethonium when used together.
See Below for More physostigmine Drug Interactions
Mechanism of Actions
Physostigmine is a reversible tertiary amine cholinesterase inhibitor, prolongs and intensifies physiological actions of acetylcholine.
Absorption: Readily absorbed from the GI tract.
Distribution: Crosses the blood brain barrier.
Metabolism: Mainly by hydrolysis of the ester linkages by cholinesterases.
Excretion: Little excreted in urine.
Storage Conditions
Parenteral: Store at 15-30°C.
ATC Classification
S01EB05 - physostigmine ; Belongs to the class of parasympathomimetics. Used in the treatment of glaucoma and miosis.
V03AB19 - physostigmine ; Belongs to the class of antidotes. Used in the management of noxious gases poisoning.
Parenteral: Store at 15-30°C.
Available As
  • Physostigmine (Eserine) 0.25%
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