Do medical toxicologists use physostigmine to treat anticholinergic toxidrome?

2.5 out of 5 stars The Use of Physostigmine by Toxicologists in Anticholinergic Toxicity. Watkins JW et al. J Med Toxicol 2014 Dec 16 [Epub ahead of print] Abstract Physostigmine is a carbamate that reversibly inhibits acetylcholinesterase, the enzyme that breaks down acetylcholine (ACh). By so doing, it increases the levels of ACh in synapses, serving as an antidote for drugs and agents causing anticholinergic syndrome. Unlike neostigmine, physostigmine crossed the blood-brain-barrier and has both peripheral and central effects. Decades ago, physostigmine was routinely used with some frequency to treat overdose with many drugs having anticholinergic actions, including tricyclic antidepressants. Then in 1980, Pentel and Peterson reported 2 patients with seizures and prolonged QRS intervals (120 and 240 msec, respectively) who suffered asystolic arrest after receiving physostigmine. After this report, tricyclic toxicity was generally considered an absolute contraindication for using physostigmine and a cardiac conduction defect (AV block) was considered a relative contraindication. A review of the literature found scant support for these contraindications. However, because of the paper by Pentel and Peterson and the uncertainty surrounding the entire issue, many clinicians avoided use of physostigmine altogether. The authors of this study retrospectively reviewed over 2 years of data from the Toxicology Investigators Consortium (ToxIC) registry to identify cases that pres...
Source: The Poison Review - Category: Toxicology Authors: Tags: Medical anticholinergic toxidrome physostigmine ToxIC registry Source Type: news