M; weight 7 to 18 kg, give 0.5 mg/dose IM; weight 18.1 to 41 kg, give 1 mg/dose IM; weight greater than 41 kg, give 2 mg/dose IM. Give 1 dose if poisoning is suspected and 2 or more mild symptoms appear (blurred vision, miosis, watery eyes, runny nose, increased salivation, chest tightness or difficulty breathing, tremors, muscle twitching, nausea or vomiting, unexplained wheezing or coughing, acute stomach cramping, tachycardia, or bradycardia). Give 2 more doses in rapid succession 10 minutes after the first if any severe symptoms appear (confusion, severe breathing difficulties, severe lung secretions, severe muscle twitching and general weakness, involuntary urination and defecation, seizures, unconsciousness). Also give 3 doses in rapid succession to a patient found unconscious and suspected of being exposed to the poison. Administer as soon as symptoms of poisoning occur (usually tearing, excess saliva, wheezing, twitching). Anticonvulsants and pralidoxime may also need to be administered concurrently.
For cholinesterase inhibitor-induced muscarinic effects prophylaxis when anticholinesterase agents (i.e., neostigmine, physostigmine, pyridostigmine) are used to reverse the neuromuscular blockade produced by curariform agents.
Intravenous Dosage
Adults
0.6 to 1.2 mg IV for each 0.5 to 2.5 mg of neostigmine or 10 to 20 mg of pyridostigmine; atropine is given a few minutes before (especially if bradycardia is present) or concurrently (in a separate syringe) with the cholinesterase inhibitor.
Children
0.05 mg/kg/dose IV (up to initial adult dose: 2 to 5 mg). Repeat/adjust dose every 10 to 20 minutes as needed; double the dose if inadequate response/atropinization to initial dose.
For adjunctive treatment of GI disorders caused by cholinergic stimulation, such as duodenal ulcer, irritable bowel syndrome, or GI hypermotility and diarrhea.
Oral Dosage
Adults
0.3 to 1.2 mg PO every 4 to 6 hours.
Children
0.01 mg/kg or 0.3 mg/m2, up to 0.4 mg, PO every 4 to 6 hours.
For mydriasis induction or cycloplegia induction.
Ophthalmic Dosage
Adults
1 drop of 1% solution instilled in eye 1 hour prior to procedure or 0.3 to 0.5 cm of 1% ointment placed in conjunctival sac up to 3 times daily.
Infants 3 months and older, Children, and Adolescents
Give 1 drop topically in the eye(s) as required or apply a small amount of the ointment in the conjunctival sac 1 to 2 times/day; take care to avoid overdosage. Typical dosage is 1 eye drop instilled 3 times/day for 3 days before the procedure in pediatric patients. In one study for cycloplegic refraction in strabismic children, 1 drop 3 times daily for 3 days prior was compared to 2 drops given 5 minutes apart; children younger than 2.5 years received a 0.5% concentration and children 2.5 years or older received 1% concentration. The differences in cycloplegic refraction were not significant between the 2 groups.
For the treatment of iritis or uveitis.
Ophthalmic Dosage (1% solution or ointment)
Adults
1 to 2 drops to the affected eye(s) up to 4 times daily. For the ointment, apply a small amount in the conjunctival sac of the affected eye(s) 1 or 2 times daily.
Children and Adolescents
1 drop to the affected eye(s) 2 to 3 times daily; 1 to 2 drops once daily has also been used. For the ointment, apply a small amount in the conjunctival sac of the affected eye(s) 1 or 2 times daily.
For the treatment of symptomatic bradycardia† (e.g., vasovagal response, AV block, or bradyarrhythmias) |
