Use standard medical measures to manage circulatory shock and metabolic acidosis. Cardiac arrhythmias may be treated with neostigmine, pyridostigmine, or propranolol. If signs of cardiac failure occur, consider the use of a short acting digitalis preparation. Close monitoring of cardiac function for not less than 5 days is advisable. Anticonvulsants may be given to control seizures.
Dialysis is of no value because of low plasma concentrations of the drug.
Physostigmine given i.v. can be used to reverse the symptoms of anticholinergic poisoning. If no clinical changes or cholinergic signs occur within 15 to 30 minutes, an additional 1 to 2 mg may be administered. Repeat doses of 1 to 2 mg i.v. Physostigmine is not innocuous and carries the risk of inducing seizures and cholinergic crisis. It should not be used routinely.