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Clinical Toxicology Volume 59, 2021 - Issue 8
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Clinical Research

A randomized trial comparing physostigmine vs lorazepam for treatment of antimuscarinic (anticholinergic) toxidrome

George Sam Wanga Section of Emergency Medicine, Department of Pediatrics, University of Colorado Anschutz Medical Campus, Children’s Hospital Colorado, Aurora, CO, USACorrespondence[email protected]
View further author information
,
Keith Bakerb Departments of Emergency Medicine and Medical Toxicology, St. Luke's University Health Network, Bethlehem, PA, USAView further author information
,
Patrick Ngc En route Care Research Center, Lackland AFB, San Antonio, TX, USAView further author information
,
Gregory C. Janisd MedTox Laboratories, Laboratory Corporation of America Holdings, Saint Paul, MN, USAView further author information
,
Jan Leonarda Section of Emergency Medicine, Department of Pediatrics, University of Colorado Anschutz Medical Campus, Children’s Hospital Colorado, Aurora, CO, USAView further author information
,
Rakesh D. Mistrya Section of Emergency Medicine, Department of Pediatrics, University of Colorado Anschutz Medical Campus, Children’s Hospital Colorado, Aurora, CO, USAView further author information
&
Kennon Hearde Department of Emergency Medicine, University of Colorado Anschutz Medical Campus, University of Colorado Hospital, Aurora, CO, USAView further author information
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Pages 698-704 | Received 12 Sep 2020, Accepted 17 Nov 2020, Published online: 09 Dec 2020

References

  • Gummin DD, Mowry JB, Spyker DA, et al. 2018 Annual report of the American Association of Poison Control Centers’ National Poison Data System (NPDS): 36th Annual Report. Clin Toxicol (Phila). 2019;57(12):1220–1413.
  • Rumack BH. Anticholinergic poisoning: treatment with physostigmine. Pediatrics. 1973;52(3):449–451.
  • Lieberman JA. Managing anticholinergic side effects. Prim Care Companion J Clin Psychiatry. 2004;6(2):20–23.
  • Watkins JW, Schwarz ES, Arroyo-Plasencia AM, et al. Toxicology Investigators Consortium. The use of physostigmine by toxicologists in anticholinergic toxicity. J Med Toxicol. 2015;11(2):179–184.
  • Beauchamp GA, Giffin SL, Horowitz BZ, et al. Poisonings associated with intubation: US National Poison Data System Exposures 2000–2013. J Med Toxicol. 2016;12(2):157–164.
  • Dawson AH, Buckley NA. Pharmacological management of anticholinergic delirium - theory, evidence and practice. Br J Clin Pharmacol. 2016;81(3):516–524.
  • Beaver KM, Gavin TJ. Treatment of acute anticholinergic poisoning with physostigmine. Am J Emerg Med. 1998;16(5):505–507.
  • Pentel P, Peterson CD. Asystole complicating physostigmine treatment in tricyclic antidepressant overdose. Ann Emerg Med. 1980;9(11):588–590.
  • Ely EW, Truman B, Shintani A, et al. Monitoring sedation stats over time in ICU patients, reliability and validity of the Richmond Agitation-Sedation Scale (RASS). JAMA. 2003;289(22):2983–2991.
  • Marcantonio ER, Ngo LH, O'Connor M, et al. 3D-CAM: derivation and validation of a 3-minute diagnostic interview for CAM-defined delirium: a cross-sectional diagnostic test study. Ann Intern Med. 2014;161(8):461–554.
  • Drug Analysis Profile, Comprehensive, Urine (791194), LabCorp. [cited 2020 Sept 9] https://www.labcorp.com/tests/related-documents/12235.
  • Burns MJ, Linden CH, Graudins A, et al. A comparison of physostigmine and benzodiazepines for the treatment of anticholinergic poisoning. Ann Emerg Med. 2000;35(4):374–381.
  • Rasimas JJ, Sachdeva KK, Donovan JW. Revival of an antidote: bedside experience with physostigmine. Toxicol Commun. 2018;2(1):85–101.
  • Crowell EB, Jr, Ketchum JS. The treatment of scopolamine-induced delirium with physostigmine. Clin Pharmacol Ther. 1967;8(3):409–414.
  • Slovis TL, Ott JE, Teitebaum DT, et al. Physostigmine therapy in acute tricyclic antidepressant poisoning. Clin Toxicol. 1971;4(3):451–459.
  • Teoh R, Page AV, Hardern R. Physostigmine as treatment for severe CNS anticholinergic toxicity. Emerg Med J. 2001;18(5):412.
  • Martin B, Howell PR. Physostigmine: going…going…gone? Two cases of central anticholinergic syndrome following anaesthesia and its treatment with physostigmine. Eur J Anaesthesiol. 1997;14(4):467–470.
  • Ceha LJ, Presperin C, Young E, et al. Anticholinergic toxicity from nightshade berry poisoning responsive to physostigmine. J Emerg Med. 1997;15(1):65–69.
  • Tobis J, Das BN. Cardiac complications in amitriptyline poisoning. Successful treatment with physostigmine. JAMA. 1976;235(14):1474–1476.
  • Snyder BD, Blonde L, McWhirter WR. Reversal of amitriptyline intoxication by physostigmine. JAMA. 1974;230(10):1433–1434.
  • Arens AM, Shah K, Al-Abri S, et al. Safety and effectiveness of physostigmine: a 10-year retrospective review. Clin Toxicol (Phila). 2018;56(2):101–107.
  • Arens AM, Kearney T. Adverse effects of physostigmine. J Med Toxicol. 2019;15(3):184–191.
  • Phillips MA, Acquisto NM, Gorodetsky RM, et al. Use of a physostigmine continuous infusion for the treatment of severe and recurrent antimuscarinic toxicity in a mixed drug overdose. J Med Toxicol. 2014;10(2):205–209.
  • Hail SL, Obafemi A, Kleinschmidt KC. Successful management of olanzapine-induced anticholinergic agitation and delirium with a continuous intravenous infusion of physostigmine in a pediatric patient. Clin Toxicol (Phila). 2013;51(3):162–166.

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