• Type: acetylcholinesterase inhibitor
  • Dosage Forms: IV/IM
  • Common Trade Names: Antilirium
  • As opposed to pyridostigmine, physostigmine does cross the blood brain barrier

Adult Dosing

Anticholinergic toxicity

  • 0.5-2 mg IV over 5 min

Non-depolarizing neuromuscular blockade reversal

  • 0.5-1 mg IM/IV q10 min prn

Pediatric Dosing

  • 0.02 mg/kg repeat every 5-10 minutes until adequate response, max of 2 mg
  • No faster than 0.5 mg/min

Special Populations

  • Pregnancy Rating: C
  • Lactation:
  • Renal Dosing
    • Adult
    • Pediatric
  • Hepatic Dosing
    • Adult
    • Pediatric


Adverse Reactions

  • Side effects: bradycardia, dysrhythmias, cholinergic excess
    • Always have atropine at the bedside for bradycardia or cholinergic excess


  • Reversible AChE inhibitor, that increases concentration of acetylcholine
  • Indirectly stimulates both nicotinic and muscarinic ACh receptors
  • Metabolism via CYP450
  • Excretion minimally via urine
  • Onset of action: 15-20min

See Also


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