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A comparison of physostigmine and benzodiazepines for the treatment of anticholinergic poisoning.
Ann Emerg Med. 2000 04; 35(4):374-81.AE

Abstract

STUDY OBJECTIVE

To compare the efficacy and safety of physostigmine with benzodiazepines for the treatment of agitation and delirium associated with anticholinergic poisoning.

METHODS

We conducted a retrospective study of 52 consecutive patients referred to a university hospital toxicology consultation service who were treated with physostigmine, benzo-diazepines, or both for anticholinergic agitation and delirium. Patients treated with physostigmine were compared with those treated with benzodiazepines with respect to demographics, severity of poisoning, response to treatment, side effects of treatment, and complications.

RESULTS

Physostigmine controlled agitation and reversed delirium in 96% and 87% of patients, respectively. Benzodiazepines controlled agitation in 24% of patients but were ineffective in reversing delirium. Initial treatment with physostigmine (n=30) resulted in a significant decrease in the incidence of agitation (P <.001) and level of central nervous system stimulation (P <.001), whereas initial treatment with benzodiazepines (n=22) did not (P =.03 and P =.05, respectively). Patients treated initially with physostigmine had a significantly lower incidence of complications (7% versus 46%; P <. 002) and a shorter time to recovery (median, 12 versus 24 hours; P =. 004) than those treated initially with benzodiazepines. There were no significant differences between these groups in the incidence of side effects (7% versus 14%; P =0.6) and length of stay (median, 32 versus 39 hours; P =.15).

CONCLUSION

Results suggest that physostigmine is more effective and safer than benzodiazepines for the treatment of anticholinergic agitation and delirium. A prospective controlled study is necessary to confirm such findings.

Authors+Show Affiliations

Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA. mburns@caregroup.harvard.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

10736125

Citation

Burns, M J., et al. "A Comparison of Physostigmine and Benzodiazepines for the Treatment of Anticholinergic Poisoning." Annals of Emergency Medicine, vol. 35, no. 4, 2000, pp. 374-81.
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):374-81.
Burns, M. J., Linden, C. H., Graudins, A., Brown, R. M., & Fletcher, K. E. (2000). A comparison of physostigmine and benzodiazepines for the treatment of anticholinergic poisoning. Annals of Emergency Medicine, 35(4), 374-81.
Burns MJ, et al. A Comparison of Physostigmine and Benzodiazepines for the Treatment of Anticholinergic Poisoning. Ann Emerg Med. 2000;35(4):374-81. PubMed PMID: 10736125.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A comparison of physostigmine and benzodiazepines for the treatment of anticholinergic poisoning. AU - Burns,M J, AU - Linden,C H, AU - Graudins,A, AU - Brown,R M, AU - Fletcher,K E, PY - 2000/3/29/pubmed PY - 2000/4/29/medline PY - 2000/3/29/entrez SP - 374 EP - 81 JF - Annals of emergency medicine JO - Ann Emerg Med VL - 35 IS - 4 N2 - STUDY OBJECTIVE: To compare the efficacy and safety of physostigmine with benzodiazepines for the treatment of agitation and delirium associated with anticholinergic poisoning. METHODS: We conducted a retrospective study of 52 consecutive patients referred to a university hospital toxicology consultation service who were treated with physostigmine, benzo-diazepines, or both for anticholinergic agitation and delirium. Patients treated with physostigmine were compared with those treated with benzodiazepines with respect to demographics, severity of poisoning, response to treatment, side effects of treatment, and complications. RESULTS: Physostigmine controlled agitation and reversed delirium in 96% and 87% of patients, respectively. Benzodiazepines controlled agitation in 24% of patients but were ineffective in reversing delirium. Initial treatment with physostigmine (n=30) resulted in a significant decrease in the incidence of agitation (P <.001) and level of central nervous system stimulation (P <.001), whereas initial treatment with benzodiazepines (n=22) did not (P =.03 and P =.05, respectively). Patients treated initially with physostigmine had a significantly lower incidence of complications (7% versus 46%; P <. 002) and a shorter time to recovery (median, 12 versus 24 hours; P =. 004) than those treated initially with benzodiazepines. There were no significant differences between these groups in the incidence of side effects (7% versus 14%; P =0.6) and length of stay (median, 32 versus 39 hours; P =.15). CONCLUSION: Results suggest that physostigmine is more effective and safer than benzodiazepines for the treatment of anticholinergic agitation and delirium. A prospective controlled study is necessary to confirm such findings. SN - 0196-0644 UR - https://wwww.unboundmedicine.com/medline/citation/10736125/A_comparison_of_physostigmine_and_benzodiazepines_for_the_treatment_of_anticholinergic_poisoning_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0196-0644(00)70057-6 DB - PRIME DP - Unbound Medicine ER -