Because strategies for the management of overdose are continually evolving, it is
advisable to contact a Poison Control Center to determine the latest recommendations
for the management of an overdose of any drug.
As in any case of overdose, general supportive measures should be utilized. Overdosage
with cholinesterase inhibitors can result in cholinergic crisis characterized by
severe nausea, vomiting, salivation, sweating, bradycardia, hypotension, respiratory
depression, collapse and convulsions. Increasing muscle weakness is a possibility
and may result in death if respiratory muscles are involved. Tertiary anticholinergics
such as atropine may be used as an antidote for ARICEPT®
overdosage. Intravenous atropine sulfate titrated to effect is recommended: an initial
dose of 1.0 to 2.0 mg IV with subsequent doses based upon clinical response. Atypical
responses in blood pressure and heart rate have been reported with other cholinomimetics
when coadministered with quaternary anticholinergics such as glycopyrrolate. It
is not known whether ARICEPT® and/or its metabolites can
be removed by dialysis (hemodialysis, peritoneal dialysis, or hemofiltration).
Dose-related signs of toxicity in animals included reduced spontaneous movement,
prone position, staggering gait, lacrimation, clonic convulsions, depressed respiration,
salivation, miosis, tremors, fasciculation and lower body surface temperature.