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Block adverse muscarinic effects of anticholinesterase agents
Adult: As sulfate: 0.2 mg for each 1 mg of neostigmine methylsulfate or the equivalent dose of physostigmine salicylate or pyridostigmine bromide given. Administer concurrently with (but in a separate syringe) or a few minutes before the anticholinesterase agent. If there is bradycardia, administer before the anticholinesterase agent to increase the pulse rate to about 80 beats/min.
Oral
Visceral spasms
Adult: As base: 0.15-0.3 mg up to 4 times daily. As sulfate: Initially, 125-250 mcg, given orally or sublingually every 4 hr or as needed. Max dose: 1.5 mg/24 hr.
Child: As sulfate: <2 yr: Weighs about 2.3 kg: Approx 12.5 mcg; 3.4 kg: 16.7 mcg; 5 kg: 20.8 mcg; 7 kg: 25 mcg; 10 kg: 31.3-33.3 mcg; 15 kg: 45.8 mcg. Max dose/24 hr: 75, 100, 125, 150, 200 and 275 mcg, respectively. 2 to <12 yr: Weighs about 10 kg: Approx 31.3-33.3 mcg; 20 kg: 62.5 mcg; 40 kg: 93.8 mcg; 50 kg: 125 mcg. Max dose: 750 mcg/24 hr. ≥12 yr: Initially, 125-250 mcg. Max dose: 1.5 mg/24 hr. Doses may be repeated every 4 hr as needed.
Child: As sulfate: <2 yr: Weighs about 2.3 kg: Approx 12.5 mcg; 3.4 kg: 16.7 mcg; 5 kg: 20.8 mcg; 7 kg: 25 mcg; 10 kg: 31.3-33.3 mcg; 15 kg: 45.8 mcg. Max dose/24 hr: 75, 100, 125, 150, 200 and 275 mcg, respectively. 2 to <12 yr: Weighs about 10 kg: Approx 31.3-33.3 mcg; 20 kg: 62.5 mcg; 40 kg: 93.8 mcg; 50 kg: 125 mcg. Max dose: 750 mcg/24 hr. ≥12 yr: Initially, 125-250 mcg. Max dose: 1.5 mg/24 hr. Doses may be repeated every 4 hr as needed.
Parenteral
Organophosphorus poisoning
Adult: As sulfate: 1-2 mg IV. Additional 1-mg doses may be given IM or IV every 3-10 min until muscarinic signs and symptoms subside and repeated if they reappear.
Parenteral
Visceral spasms
Adult: As sulfate: 0.25-0.5 mg IM or IV or SC every 4 hr.
Parenteral
Preoperative medication
Adult: As sulfate: 5 mcg/kg given IV, IM or SC 30-60 minutes prior to induction of anaesthesia or at the time other preanaesthetic medications are given.
Child: As sulfate: >2 yr: 5 mcg/kg given IV, IM or SC 30-60 min prior to induction of anaesthesia or at the time other preanaesthetic medications are given.
Child: As sulfate: >2 yr: 5 mcg/kg given IV, IM or SC 30-60 min prior to induction of anaesthesia or at the time other preanaesthetic medications are given.