Usual Adult Dose for Anesthesia

Preanesthetic: 0.004 mg/kg intramuscularly 30 to 60 minutes prior to anticipated induction of anesthesia.

Intraoperative: 0.1 mg intravenously; repeat every 2 to 3 minutes as needed

• Use to counteract drug-induced or vagal reflexes associated with arrhythmias (e.g. bradycardia)
• The usual attempts should be made to determine the cause of cardiac arrhythmias; perform surgical or anesthetic manipulations needed to correct parasympathetic imbalance.

Neuromuscular blockage reversal: 0.2 mg for each 1.0 mg neostigmine or 5.0 mg pyridostigmine

• Drugs may be administered together (simultaneous intravenous injection or mixed in the same syringe) to minimize appearance of cardiac effects.

Comments:

• The injectable product contains benzoyl alcohol.

Uses: During anesthesia induction and intubation, to reduce salivary, tracheobronchial, and pharyngeal secretions, to reduce the volume and free acidity of gastric secretions, and to block cardiac vagal inhibitory reflexes

Usual Adult Dose for Peptic Ulcer

Oral tablets:
1 mg oral tablets: 1 mg orally 3 times a day (morning, afternoon, and bedtime)

• Some patients will require 2 mg at bedtime to assure overnight symptom control

2 mg oral tablets: 2 mg orally twice to 3 times a day at equally spaced intervals
Maximum dose: 8 mg daily

• Titrate dose based on response and adverse effects

Injection solution:
0.1 mg intramuscularly or intravenously every 4 hours three or four times a day

• May use 0.2 mg if a more profound effect is required.

Maximum dose: 4 doses per day

• Some patients may need only a single dose; base frequency of administration on patient response.

Comments:

• The injectable product contains benzoyl alcohol.

Uses: Adjunctive treatment of peptic ulcer

Usual Adult Dose for Chronic Obstructive Pulmonary Disease - Maintenance

Solution for inhalation: Inhale contents of one vial twice a day using accompanying nebulization system

Capsules for inhalation: Inhale contents of one capsule twice a day using accompanying inhaler

Comments:

• For inhalation only - do not swallow.
• Administer at the same time of day.
• More frequent administration or higher doses are not recommended.

Use: Long term maintenance treatment of airflow obstruction in chronic obstructive pulmonary disease (COPD) including chronic bronchitis and/or emphysema

Usual Pediatric Dose for Anesthesia

Preanesthetic: 0.004 mg/kg intramuscularly 30 to 60 minutes prior to anticipated induction of anesthesia.

• Infants (1 month to 2 years) may require up to 0.009 mg/kg

Intraoperative: 0.004 mg intravenously; repeat every 2 to 3 minutes as needed
Maximum dose: 0.1 mg per single dose

• Because of its long half-life, additional doses are rarely needed
• Use to counteract drug-induced or vagal reflexes associated with arrhythmias (e.g. bradycardia)
• The usual attempts should be made to determine the cause of cardiac arrhythmias; perform surgical or anesthetic manipulations needed to correct parasympathetic imbalance.

Neuromuscular blockage reversal: 0.2 mg for each 1.0 mg neostigmine or 5.0 mg pyridostigmine

• Drugs may be administered together (simultaneous intravenous injection or mixed in the same syringe) to minimize appearance of cardiac effects.

Comments:

• The injectable product contains benzoyl alcohol.

Uses: During anesthesia induction and intubation, to reduce salivary, tracheobronchial, and pharyngeal secretions, to reduce the volume and free acidity of gastric secretions, and to block cardiac vagal inhibitory reflexes

Usual Pediatric Dose for Excessive Salivation

1 mg/5 mL oral liquid, children 3 to 16 years:
Initial dose: 0.02 mg/kg orally 3 times a day, at least one hour before or 2 hours after meals

• Titrate in increments of 0.02 mg/kg every 5 to 7 days, based on response and adverse effects

Maximum dose: 0.1 mg/kg 3 times a day, not to exceed 1.5 to 3 mg per dose based on weight

Use: To reduce chronic severe drooling in patients aged 3 to 16 years with conditions associated with problem drooling (e.g. cerebral palsy)

Renal Dose Adjustments

Dose adjustment(s) may be required; however, no specific guidelines have been suggested. Caution is recommended. (intravenous solution)
No adjustment recommended for mild to moderate renal impairment (inhalation powder/solution)
Use with caution (oral tablets)

• Renal elimination may be severely impaired in renal failure.

Liver Dose Adjustments

No adjustment recommended (inhalation powder)
Use with caution (oral tablets)

Precautions

• Hypersensitivity to any of the ingredients
• In managing peptic ulcer, because of the longer duration of therapy, may be contraindicated in: glaucoma, obstructive uropathy (e.g. bladder neck obstruction due to prostatic hypertrophy), obstructive gastrointestinal disease (e.g. achalasia, pyloroduodenal stenosis), paralytic ileus, intestinal atony of the elderly or debilitated, unstable cardiovascular status in acute hemorrhage, severe ulcerative colitis, toxic megacolon complicating ulcerative colitis, myasthenia gravis

Safety and efficacy of the inhalation powder have not been established in patients younger than 18 years.

Safety and efficacy of the oral tablets have not been established in patients younger than 12 years.

Safety and efficacy of the oral liquid have not been established in patients younger than 3 years.

Consult WARNINGS section for additional precautions.

Dialysis

Data not available

Other Comments

IV compatibility:

• Compatible with: Dextrose 5% and 10%, saline, dextrose 5% in sodium chloride 0.45%, sodium chloride 0.9%, and Ringer's Injection
• Incompatible with: Lactated Ringer's solution

Patient advice:

• This drug may cause blurred vision or drowsiness; do not engage in activities requiring mental alertness and/or visual acuity such as operating machinery or a motor vehicle, or when performing hazardous tasks.