Also has been administered by intraosseous (IO) injection† in the ACLS setting, generally when IV access not readily available; onset of action and systemic concentrations are comparable to those achieved with venous administration.
however, oral dosage form no longer commercially available in US.
Because heart rate is a major determinant of myocardial oxygen requirements, excessive rate acceleration in patients with acute myocardial ischemia or infarction may worsen ischemia or increase extent of infarction.
Large or toxic doses or usual doses in patients with excess susceptibility may produce marked CNS disturbances (e.g., ranging from marked excitement, ataxia, hallucination, depression, and/or disorientation to active delirium to coma to death [secondary to respiratory failure]).
Has been administered via oral inhalation for bronchodilation; however, solution for inhalation no longer commercially available in US.
auto-injector may be self-administered by the patient or caregiver in an out-of-hospital setting to facilitate the initial treatment of muscarinic poisoning (usually breathing difficulty secondary to increased secretions); however, definitive medical care should be sought immediately.
In general, dose selection for an elderly patient should be cautious, usually starting at the low end of the dosing range, reflecting the greater frequency of decreased hepatic, renal, or cardiac function, and of concomitant disease or other drug therapy.
Administer with extreme caution when the symptoms of nerve agent poisoning are less severe in patients with disorders of heart rhythm (e.g., atrial flutter), substantial renal insufficiency, or a recent MI.
However, not likely to be effective in patients with type II second-degree or third-degree AV block, including third-degree AV block accompanied by a new wide QRS complex where location of block is at or below the His-Purkinje level; transcutaneous pacing or rate-accelerating β-adrenergic drugs (e.g., dopamine or epinephrine) preferred in these patients until transvenous pacing can be performed. Used to prevent other cholinergic effects during surgery (e.g., cardiac arrhythmias, hypotension, bradycardia) secondary to excessive vagal stimulation, carotid sinus stimulation, or pharmacologic effect of drugs (e.g., succinylcholine). Not routinely recommended because of lack of supporting evidence, but may be considered in situations where there is an increased risk of bradycardia (e.g., when succinylcholine is used to facilitate intubation). Provigil is a medication which helps to fight sleepiness in excess.However, current surgical practice (e.g., using general anesthetics that do not stimulate salivary and tracheobronchial secretions) has reduced the need to control excessive respiratory secretions during surgery. IMODIUM® A-D: Diarrhea Caplets & Diarrhea Liquid Treatment.