Physostigmine reversal of scopolamine delirium in obstetric patients

The Pharmacology of Physostigmine

“…The current clinical roles of physostigmine include treatment of glaucoma (172,258), myasthenia gravis (276), the relief of central cholinergic intoxication from atropine, scopolamine, and belladonna alkaloids (65,212,238,277) and from the intoxication induced by overdoses of tricyclic antidepressants (48,182,188,236), antihistamines (149), antipsychotics (27,279), and benzodiazepines (133,215). These actions all derive from the ability of physostigmine to increase acetylcholine levels by inhibition of AChE and BuChE.…”

Physostigmine’s effect on diminished fetal heart rate variability caused by scopolamine, meperidine and propiomazine

“…Matemal responses to blood pressure and pulse after inf sion.of physostigmine are minimal and are in agreement with other studies. SMILER, et al recorded no adverse effects of physostigmine in doses of 3 mg intravenously on the fetus or mother and noted no fetal or maternal bradycardia [3], Matemal br dycardia (less than 50 beats per minute) was not noted in any of our patients studied, however, one was noted to have a pulse rate of 56 beats per minute. This patient was given a total of 4 mg of physostigmine.…”

“…Because of this, it might be beneflcial to attempt to reverse this drug induced loss of fetal heart rate variability if, during labor, confusion arose äs to its importance in assessing fetal distress. Since physostigmine can be used to reverse the delirium resulting when scopolamine is given to an adult [3] and since it is a drug well known for its anticholinesterase activity, physostigmine was given to patients in labor previously given scopolamine alone and meperidine and propiomazine in combination to ascertain the effect on reversing the loss of fetal heart rate variability caused by the administration of these drugs.…”

“…Physostigmine, an anticholinesterase drug and capable of crossing the blood brain barrier, has been noted to be able to reverse the delirium produced by atropine like drugs [3]. Its effect, however, on fetal heart rate variability has not been previously studied.…”

Are there teratogenic risks associated with antidotes used in the acute management of poisoned pregnant women?

“…Case reports describing adverse events possibly related to naloxone use near delivery for reversal of opiate effects, but not overdose, have been published (Schoenfeld et al, 1987; Sun, 1998). The effect of physostigmine during pregnancy has been described in two studies, but not for overdose (Smiller et al, 1973; Boehm et al, 1977). In the first study, physostigmine was used in 15 pregnant women at term to reverse the effect of scopolamine (Smiller et al, 1973).…”