Tonic convulsions and cardiovascular collapse following an injection of prostigmin

Abstract

Extensive reports have been published on the use of cholinergic drugs to evoke menstruation in the absence of organic disease or pregnancy. However, none of the authors mention any serious side effects. It is the purpose of this paper to report one case of tonic convulsions and cardiovascular collapse following a single 1.0 mg. intramuscular injection of Prostigmin.Decker1 reported “no toxic effects or side effects” in a series of 101 cases, even using such large amounts as 2.0 mg. of Stigmonene. Hinman and Roby,2 in a series of Prostigmin tolerance trials in 70 patients, stated that there were no objective signs and the only subjective symptoms were slight dizziness. headache, nausea and vomiting, salivation, and diarrhea. Thick tongue and difficulty of speech of a transient nature were noted in two cases. Soskin and associates3 reported no unpleasant subjective or objective effects from Prostigmin in 50 patients. Carapetyan,4 Thelen,5 Parella,6 Douglas,7 and Sneider8 in their series of cases reported no toxic effects from Prostigmin therapy.We have been using Prostigmin in 0.5 and 1.0 mg. doses intramuscularly for three successive days for eliciting menstrual flow in those patients who have amenorrhea with no demonstrable organic pathology, in those patients who have amenorrhea for eight or more weeks post partum (not lactating), and occasionally for the diagnosis of early pregnancy. It has been our impression that many patients with delayed menstruation become emotionally upset over fear of pregnancy, and this anxiety may cause a “sympathetic blockade” of the acetylcholine necessary for uterine vasodilation and hyperemia necessary for the onset of menstruation. This may, in turn, prolong the amenorrhea. Prostigmin inhibits cholinesterase, the tissue enzyme which destroys acetylcholine3,4