Rivastigmine for the treatment of anticholinergic delirium following severe procyclidine intoxication

Kernebeek, Michiel W van; Ghesquiere, M; Vanderbruggen, Nathalie; Verhoeven, Elisa M H; Hubloue, Ives; Crunelle, Cleo L.

doi:10.1080/15563650.2020.1818768

Cited by 16 publications

(7 citation statements)

References 3 publications

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“…In our study, rivastigmine was used following successful reversal of delirium with physostigmine due to favourable pharmacokinetics with longer duration of action (10 h). Rivastigmine has been used to treat prolonged delirium in anticholinergic syndrome as it could reduce symptom recurrence and decrease need for re‐dosing 13,14 . Furthermore, bromocriptine was chosen as it has minimal side effects and has been suggested for the management of extrapyramidal symptoms such as rigidity and dystonia 15 .…”

Section: Discussionmentioning

confidence: 99%

“…Rivastigmine has been used to treat prolonged delirium in anticholinergic syndrome as it could reduce symptom recurrence and decrease need for re‐dosing. 13 , 14 Furthermore, bromocriptine was chosen as it has minimal side effects and has been suggested for the management of extrapyramidal symptoms such as rigidity and dystonia. 15 This proposed treatment as highlighted by the case may provide substantial opportunity to lessen or shorten symptoms of this adverse reaction.…”

Section: Discussionmentioning

confidence: 99%

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Case series profile of olanzapine post‐injection delirium/sedation syndrome

Seebaluck

Downes

Brown

et al. 2022

Brit J Clinical Pharma

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Olanzapine pamoate is an intramuscular depot injection for the treatment of schizophrenia. Approximately 1.4% of patients develop a serious adverse event called post‐injection delirium/sedation syndrome (PDSS), characterised by drowsiness, anticholinergic and extrapyramidal symptoms. The objective is to investigate olanzapine PDSS presentations including clinical features and treatment approach. This is a retrospective review of olanzapine PDSS patients from three toxicology units and the NSW Poisons Information Centre between 2017 and 2022. Adult patients were included if they had intramuscular olanzapine then developed PDSS criteria. Clinical symptoms, treatment, timing and length of symptoms were extracted into a preformatted Excel database. There were 18 patients included in the series, with a median age of 49 years (interquartile range [IQR]: 38–58) and male predominance (89%). Median onset time post injection was 30 min (IQR: 11–38). PDSS symptoms predominate with drowsiness, confusion and dysarthria. Median length of symptoms was 24 h (IQR: 20–54). Most common treatment included supportive care without any pharmacological intervention (n = 10), benzodiazepine (n = 4) and benztropine (n = 3). In one case, bromocriptine and physostigmine followed by oral rivastigmine were given to manage antidopaminergic and anticholinergic symptoms respectively. This proposed treatment combination could potentially alleviate some of the symptoms but needs further studies to validate the findings. In conclusion, this case series supports the characterisation of PDSS symptomology predominantly being anticholinergic with similar onset (<1 h) and duration (<72 h). Bromocriptine is proposed to manage PDSS if patients develop severe dopamine blockade and physostigmine followed by rivastigmine for anticholinergic delirium.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Case series profile of olanzapine post‐injection delirium/sedation syndrome

Seebaluck

Downes

Brown

et al. 2022

Brit J Clinical Pharma

View full text Add to dashboard Cite

show abstract

“…Rivastigmine was used following successful reversal of delirium with physostigmine due to favourable pharmacokinetics with longer duration of action (10h). Rivastigmine has been used to treat prolonged delirium in anti-cholinergic syndrome as it could reduce symptom recurrence and decrease need for re-dosing 12,13 . Furthermore, bromocriptine was chosen as it has been suggested for the management of extrapyramidal symptoms such as rigidity and dystonia 14 .…”

Section: Discussionmentioning

confidence: 99%

Case Series Profile of Olanzapine Post-Injection Delitrium/Sedation Syndrome

Seebaluck¹,

Downes

Brown

et al. 2022

Preprint

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Olanzapine pamoate is an intramuscular depot injection for the treatment of schizophrenia. Approximately 1.4% of patients develop a serious adverse event called Post Injection Delirium/Sedation Syndrome (PDSS); characterised by drowsiness, anticholinergic and extrapyramidal symptoms. The objective is to investigate olanzapine PDSS presentations including clinical features and treatment approach. This is a retrospective review of olanzapine PDSS patients from three toxicology units and the NSW Poisons Information between 2017 and 2022. Adult patients were included if they had intramuscular olanzapine then developed PDSS criteria. Clinical symptoms, treatment, timing and length of symptoms were extracted into a preformatted Excel database. There were 18 patients included in the series, with a median age of 49 years (IQR: 38-58) and male predominance (89%). Median onset time post injection was 30 minutes (IQR: 11-38). PDSS symptoms predominate with drowsiness, confusion and dysarthria. Median length of symptoms was 24 hours (IQR: 20-54). Most common treatment included supportive care without any pharmacological intervention (n=10), benzodiazepine (n=4) and benztropine (n=3). In one case, bromocriptine and physostigmine followed by oral rivastigmine were given to manage anti-dopaminergic and anti-cholinergic symptoms respectively. This proposed treatment combination could alleviate some of the symptoms. In conclusion, this case series supports the characterisation of PDSS symptomology predominantly being anti-cholinergic with similar onset (<1 hour) and duration (<72hours). A combination of bromocriptine and physostigmine followed by rivastigmine is proposed to manage PDSS if patients develop severe dopamine blockade or anti-cholinergic delirium.

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“…Recent case reports describe that rivastigmine has been used to treat anticholinergic poisoning; however, its use may be limited by the inability of patients to take the medication orally and the slow absorption when administered as a transdermal patch. 57 Until further research is published on alternatives, the most prudent management is intravenous benzodiazepines.…”

Section: Supportive Care and Focused Antidotementioning

confidence: 99%

Part I: Case series: Acute management of prescription and nonprescription drug overdoses

Feldman,

Leonard

2024

J Am Coll Clin Pharm

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Reviewed by Julianne Yeary, Pharm.D., BCCCP; and Monica Owen, Pharm.D., BCPS, BCCCP LEARNING OBJECTIVES 1. Classify prescription drug overdose by patient presentations.2. Evaluate the causative agents of a drug overdose based on history and clinical findings of presentation.3. Develop a treatment paradigm that may be applied in all prescription drug overdoses.4. Assess the relevance of each therapeutic target in drug overdose in a specific drug overdose scenario.5. Devise a plan for treatment of anticholinergic, sodium channel blocker, tricyclic antidepressant, bupropion, digoxin, sulfonylurea, alpha-2 agonist, iron, valproic acid, clonidine, and salicylate overdose.6. Justify the use of specific antidotes in overdose.Target audience for this application-based activity: Pharmacotherapy specialists and advanced level clinical pharmacists whose practice involves the direct care and management of critically ill patients in the ICU and emergency department.

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Rivastigmine for the treatment of anticholinergic delirium following severe procyclidine intoxication

Cited by 16 publications

References 3 publications

Case series profile of olanzapine post‐injection delirium/sedation syndrome

Case series profile of olanzapine post‐injection delirium/sedation syndrome

Case Series Profile of Olanzapine Post-Injection Delitrium/Sedation Syndrome

Part I: Case series: Acute management of prescription and nonprescription drug overdoses

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