Name: Antilirium

What should I discuss with my healthcare provider before receiving Antilirium (physostigmine)?

You should not be treated with physostigmine if you are allergic to it, or if you have:

  • asthma;

  • diabetes;

  • bladder obstruction or other urination problems;

  • a blockage in your digestive tract (stomach or intestines);

  • heart disease; or

  • gangrene (damaged skin and muscle tissue caused by infection or lack of blood supply).

If possible before you receive physostigmine, tell your doctor if:

  • you have a sulfite allergy;

  • you have recently taken Ultracet (acetaminophen with tramadol); or

  • you regularly take bupropion (Wellbutrin, Zyban, Aplenzin, Forfivo, and others).

In an emergency situation it may not be possible to tell your caregivers if you are pregnant or breast-feeding. Make sure any doctor caring for your pregnancy or your baby knows you have received this medicine.

What other drugs will affect Antilirium (physostigmine)?

Other drugs may interact with physostigmine, including prescription and over-the-counter medicines, vitamins, and herbal products. Tell each of your health care providers about all medicines you use now and any medicine you start or stop using.

Advice to Patients

  • Importance of women informing clinicians if they are or plan to become pregnant or plan to breast-feed.149

  • Importance of informing clinician of existing or contemplated concomitant therapy, including prescription and OTC drugs and dietary or herbal supplements, as well as any concomitant illnesses.149

  • Importance of informing patients of other important precautionary information.149 (See Cautions.)

Antilirium Dosage

Physostigmine is injected into a muscle or into a vein through an IV. A healthcare provider will give you this injection.

When injected into a vein, physostigmine must be given slowly.

Your breathing, blood pressure, oxygen levels, and other vital signs will be watched closely while you are receiving physostigmine.

You may need repeat doses of this medicine, depending on how your body responds to it. Your doctor will determine how long to treat you with physostigmine.

Since this medicine is given by a healthcare professional in a medical setting, an overdose is unlikely to occur.

Because you will receive physostigmine in a clinical setting, you are not likely to miss a dose.

For the Consumer

Applies to physostigmine: parenteral injection

Side effects include:

Nausea, vomiting, epigastric pain, miosis, salivation, sweating, lacrimation, dyspnea, bronchospasm.

For Healthcare Professionals

Applies to physostigmine: injectable solution


Frequency not reported: Nausea, vomiting, hypersalivation[Ref]

Nausea, vomiting, and salivation can be offset by a reduction in dosage.[Ref]


Frequency not reported: Bradycardia[Ref]

Bradycardia may occur if intravenous administration is too rapid.[Ref]

Nervous system

Convulsions may occur if intravenous administration is too rapid.[Ref]

Frequency not reported: Convulsions[Ref]

Some side effects of Antilirium may not be reported. Always consult your doctor or healthcare specialist for medical advice. You may also report side effects to the FDA.

Usual Adult Dose for Anticholinergic Syndrome

Post anesthesia care:

Initial dose: 0.5 to 1 mg, IM or slow IV, at no more than 1 mg/minute
-May repeat dose at 10 to 30 minute intervals if desired response is not obtained

Overdose of drugs that cause anticholinergic syndrome:

2 mg, IM or slow IV, at no more than 1 mg/minute
-May repeat dose if life threatening signs (e.g. arrhythmia, convulsions, coma) occur

Physostigmine Levels and Effects while Breastfeeding

Summary of Use during Lactation

No information is available on the use of physostigmine during breastfeeding.

Drug Levels

Maternal Levels. Relevant published information was not found as of the revision date.

Infant Levels. Relevant published information was not found as of the revision date.

Effects in Breastfed Infants

Relevant published information was not found as of the revision date.

Effects on Lactation and Breastmilk

Relevant published information in nursing mothers was not found as of the revision date. In animals, cholinergic drugs increase oxytocin release,[2] and have variable effects on serum prolactin.[3] Physostigmine increases serum prolactin in humans.[4][5] The prolactin level in a mother with established lactation may not affect her ability to breastfeed.


1. Clarke G, Fall CH, Lincoln DW, Merrick LP. Effects of cholinoceptor antagonists on the suckling-induced and experimentally evoked release of oxytocin. Br J Pharmacol. 1978;63:519-27. PMID: 566601

2. Muller EE, Locatelli V, Cella S et al. Prolactin-lowering and -releasing drugs: mechanisms of action and therapeutic applications. Drugs. 1983;25:399-432. PMID: 6133737

3. Risch SC, Janowsky DS, Siever LJ al. Correlated cholinomimetic-stimulated beta-endorphin and prolactin release in humans. Peptides. 1982;3:319-22. PMID: 6289276

4. Risch SC, Janowsky DS, Siever LJ et al. Cholinomimetic-induced co-release of prolactin and beta-endorphin in man. Psychopharmacol Bull. 1982;18:21-5. PMID: 6296908