Safety and effectiveness of physostigmine: a 10-year retrospective review

Abstract

In this retrospective cohort study, physostigmine administration to reverse anticholinergic delirium had a good safety profile, and often improved or resolved anticholinergic delirium when administered in doses less than 2 mg.

Physostigmine is superior to non-antidote therapy in the management of antimuscarinic delirium: a prospective study from a regional poison center

“…In this prospective observational study, we confirmed previously reported findings [8,[14][15][16][17] that physostigmine is effective in treating antimuscarinic delirium. Patients with antimuscarinic delirium that the CSPI recognized as one who would benefit from intervention and who were given physostigmine had improved delirium more often both by AMSS as well as by subjective report at two hours than those who were not, with an odds ratio of greater than 6.…”

“…These findings resemble those of Rasimas et al [16], who found one arrhythmia each in the prospective and retrospective arms of their study, both thought not to be directly related to the administration of physostigmine. Similarly, Burns [14] reported one episode of bradycardia, while Arens et al [17] and Nguyen et al [18] reported no arrhythmias related to physostigmine administration in their cohorts.…”

“…Finally, in a retrospective study of patients with clinical 2 (1 to 2) Ã 1 (-1 to 1) Ã Ã Statistically significant difference between the physostigmine and no physostigmine groups with p value <.05 using Fisher's exact test. antimuscarinic delirium given physostigmine at a single poison center, Arens et al [17] reported improvement or resolution in delirium in 73% of 191 patients after a single dose of physostigmine. Previously reported frequencies of adverse events related to physostigmine [8,14,[16][17][18] are similar to the present study.…”

“…antimuscarinic delirium given physostigmine at a single poison center, Arens et al [17] reported improvement or resolution in delirium in 73% of 191 patients after a single dose of physostigmine. Previously reported frequencies of adverse events related to physostigmine [8,14,[16][17][18] are similar to the present study. Despite including patients without regard to QRS interval or presence of co-ingested sodium channel antagonists in our study, there were no episodes of wide complex tachycardia or bradycardia in the physostigmine group.…”

“…The use of physostigmine declined [5] following a two patient case series published in 1980 by Pentel and Peterson [13] that reported two episodes of asystole temporally associated with physostigmine administration. Despite this, several researchers have continued to investigate the safety and efficacy of the antidote [8,[14][15][16][17]. Multiple observational studies have demonstrated the safety of physostigmine in a variety of contexts [15][16][17][18], but few have compared physostigmine use to non-antidote therapy in a prospective fashion, and none have done so via telephone recommendations from a regional poison center (PC).…”