Initially 1.5 mg bd. May be increased if well tolerated after a min of 2 wk of treatment to 3 mg bd. Subsequent dose increase to 4.5 mg bd up to a max of 6 mg bd may be considered based on good tolerability of current dose. Patients sensitive to the effects of cholinergic drugs Initially 1 mg bd.
If treatment is interrupted for >3 days, it should be re-initiated w/ lowest daily dose. GI disorders may occur at initiation of therapy & shortly after dose increase. Monitor patient's wt during therapy. Sick sinus syndrome, conduction defects (SA & AV blocks); predisposed to increased gastric acid secretion, urinary obstruction & seizures; history of asthma or obstructive pulmonary disease. May induce or exacerbate extrapyramidal symptoms. Discontinue if allergic contact dermatitis occur. Patient <50 kg body wt. Hepatic & renal impairment. May impair ability to drive or operate machinery. Pregnancy & lactation. Ped patient.
Possible additive extrapyramidal effect w/ metoclopramide. Additive effects w/ other cholinomimetic drugs; anticholinergic drugs (eg, oxybutynin, tolterodine). May exaggerate the effects of succinylcholine-type muscle relaxants during anaesth. Additive effects leading to bradycardia w/ β-blockers. Increased oral clearance w/ nicotine.