SCCM Resource Library-Drug Shortage Alert: Physostigmine

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Physostigmine, a medication used to treat antimuscarinic toxicity, is currently facing a shortage due to problems with the United States manufacturer, Akorn Pharmaceuticals. This shortage has been ongoing since March 2021, and the impact is significant for adult and pediatric patients. The shortage requires careful management strategies to optimize the use of available physostigmine supply. <br /><br />Institutions may need to reserve remaining stocks of physostigmine for patients with severe and refractory antimuscarinic toxicity or for the prevention of intubation. Rapid diagnosis and exclusion of alternative life-threatening diagnoses are important in identifying patients who would benefit most from physostigmine. It is recommended to consult with a toxicologist before using physostigmine in patients with tricyclic antidepressant overdose, seizure, or signs of sodium channel blockade. <br /><br />In the absence of physostigmine, alternative medications such as benzodiazepines and dexmedetomidine can be considered for managing central antimuscarinic toxicity and associated agitation. However, caution must be exercised with the use of antipsychotics, as they may exacerbate antimuscarinic toxicity. Additionally, centrally acting acetylcholinesterase inhibitors prescribed for dementia, such as rivastigmine, galantamine, and donepezil, may be considered as alternatives or adjuncts to physostigmine. <br /><br />It is important to note that available therapeutic alternatives have limitations and safety implications. Careful dosing and monitoring are necessary to prevent cholinergic toxicity. Communication and education among healthcare professionals, as well as clear prescribing information, are crucial in managing the shortage and ensuring patient safety. Institutions should develop drug shortage mitigation strategies and involve multiprofessional groups in the decision-making process. <br /><br />Overall, this drug shortage alert provides recommendations and information on managing the shortage of physostigmine, including potential alternative medications and safety considerations. Clinicians are advised to consult with their institution's staff and experts in toxicology for guidance on appropriate management strategies.

Asset Subtitle

Pharmacology, Crisis Management, 2023, 0:02:00

Meta Tag

Content Type Article

Knowledge Area Pharmacology

Knowledge Area Crisis Management

Membership Level Nonmember

Membership Level Associate

Membership Level Professional

Membership Level Select

Tag Resource Allocation

Year 2023

Keywords

Physostigmine

antimuscarinic toxicity

shortage

Akorn Pharmaceuticals

medication

management strategies

diagnosis

alternative medications

patient safety

drug shortage

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