PHYSOSTIGMINE

Drugs in Pregnancy and Lactation.

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Name: PHYSOSTIGMINE
Class: Parasympathomimetic (Cholinergic)
Risk Factor:    C

Fetal Risk Summary

Physostigmine is rarely used in pregnancy. No reports linking its use with congenital defects have appeared. One report described its use in 15 women at term to reverse scopolamine-induced twilight sleep (1). Apgar scores of 14 of the newborns ranged from 7 to 9 at 1 minute and 8 to 10 at 5 minutes. One infant was depressed at birth and required resuscitation, but the mother had also received meperidine and diazepam. No other effects in the infants were mentioned.

Physostigmine is an anticholinesterase agent, but it does not contain a quaternary ammonium element. It crosses the blood-brain barrier and should be expected to cross the placenta (2).

Transient muscular weakness has been observed in about 20% of newborns of mothers with myasthenia gravis (3,4 and 5). The neonatal myasthenia is caused by transplacental passage of anti-acetylcholine receptor immunoglobulin G antibodies (5).

Breast Feeding Summary

No data are available.

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References

  1. Smiller BG, Bartholomew EG, Sivak BJ, Alexander GD, Brown EM. Physostigmine reversal of scopolamine delirium in obstetric patients. Am J Obstet Gynecol 1973;116:326–9.
  2. Taylor P. Anticholinesterase agents. In Gilman AG, Goodman LS, Gilman A, eds. The Pharmacological Basis of Therapeutics. 6th ed. New York, NY:Macmillan, 1980:100–19.
  3. McNall PG, Jafarnia MR. Management of myasthenia gravis in the obstetrical patient. Am J Obstet Gynecol 1965;92:518–25.
  4. Blackhall MI, Buckley GA, Roberts DV, Roberts JB, Thomas BH, Wilson A. Drug-induced neonatal myasthenia. J Obstet Gynaecol Br Commonw 1969;76:157–62.
  5. Plauche WG. Myasthenia gravis in pregnancy: An update. Am J Obstet Gynecol 1979;135:691–7.

Index

Q&A about Physostigmine

azaria31...
How is Physostigmine Synthesized?
uncle buck
Physostigmine (also known as eserine) is a parasympathomimetic, specifically, a reversible cholinesterase inhibitor obtained from the Calabar bean. By interfering with the metabolism of acetylcholine, physostigmine indirectly stimulates both nicotinic and muscarinic receptors. The chemical was synthesized for the first time in 1935 by the chemists Percy Lavon Julian and Josef Pikl.

Clinical Uses

Physostigmine is used to treat glaucoma and delayed gastric emptying. Because it is a tertiary amine, it can cross the blood-brain barrier and so it is also used to treat the central nervous system effects of atropine, scopolamine and other anticholinergic drug overdoses.

Possible side effects include depression.

Overdose can cause a cholinergic syndrome.

Physostigmine is available in the U.S. under the trade names Antilirium, Eserine Salicylate, Isopto Eserine, and Eserine Sulfate.

Intravenous injection of physostigmine (0.5mg-2mg) can be used to reverse GHB overdose, although careful control of dose is needed to avoid convulsions; often a small dose of an anticonvulsant such as diazepam is administered first to counteract the lowering of seizure threshold from the physostigmine.
Rayan p
what efect of atropine and physostigmine have had responsed to nicotine ? explain?
SAMI
By interfering with the metabolism of acetylcholine, physostigmine indirectly stimulates both nicotinic and muscarinic receptors.

Nicotine speeds up heart rate that is slowed by atropine which is a parasympatholytic.
the_sign...
What medications/drugs contain the chemicals Phentolamine , tolazoline, pilocarpine, physostigmine, or Acetazo
What medications/drugs contain the chemicals Phentolamine , tolazoline, pilocarpine, physostigmine, or Acetazolamide?
belfus
those are all glaucoma medications
liz
what foods contain physostigmine?
can you name some foods that contain this?
patois
Baka
why is phenylephrine used for dilation over physostigmine or pilocarpine?
rnrayunr...
Both physostigmine and philocarpine are parasympathomimetics (mimic the parasympathetic nervous system). This can lead to bradycardias (slow heart rates) and excessive lacramentation (tearing of the eyes). Phenylephrine is an alpha agonist (alpha receptors of the sympathetic nervous system) and causes local vasoconstriction and mydriasis (dilation of the pupil). Phenylephrine is also a common nasal decongestant. There are better medications for mydriasis than any of the above.