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Physostigmine: is there a role for this antidote in pediatric poisonings?
Curr Opin Pediatr. 2007 Apr; 19(2):201-5.CO

Abstract

PURPOSE OF REVIEW

Ingestion of anticholinergic medications is common in pediatrics. Toxicity may result in symptoms such as severe agitation requiring physical restraint. Physostigmine, an antidote for anticholinergic poisoning, could be useful in this situation. Many physicians are hesitant to use physostigmine after case series suggested its use in tricyclic antidepressant overdose was associated with asystole. This paper reviews the anticholinergic toxidrome and pathophysiology, recent literature on the efficacy and toxicity of physostigmine, and its dosing, indications, and contraindications.

RECENT FINDINGS

Recent articles suggest that toxicity associated with physostigmine consists mostly of seizures and cardiac arrhythmia, and occurs when used in the absence of anticholinergic symptoms. Despite potential complications, physostigmine has been shown to be useful in cases of confirmed anticholinergic poisoning by controlling agitation and reversing delirium, and appears to be safer and more effective than benzodiazepines in this situation.

SUMMARY

In the proper clinical situation such as pure anticholinergic overdose with severe symptoms, physostigmine can be beneficial. The potential for side effects is not insignificant, and the antidote should be used with caution in any patient with unknown ingestions or those with cardiac conduction defects. More research is needed, especially involving children, before we will fully understand the indications and toxicities associated with physostigmine.

Authors+Show Affiliations

Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama 35233, USA. nfrascogna@peds.uab.edu

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

17496766

Citation

Frascogna, Nan. "Physostigmine: Is There a Role for This Antidote in Pediatric Poisonings?" Current Opinion in Pediatrics, vol. 19, no. 2, 2007, pp. 201-5.
Frascogna N. Physostigmine: is there a role for this antidote in pediatric poisonings? Curr Opin Pediatr. 2007;19(2):201-5.
Frascogna, N. (2007). Physostigmine: is there a role for this antidote in pediatric poisonings? Current Opinion in Pediatrics, 19(2), 201-5.
Frascogna N. Physostigmine: Is There a Role for This Antidote in Pediatric Poisonings. Curr Opin Pediatr. 2007;19(2):201-5. PubMed PMID: 17496766.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Physostigmine: is there a role for this antidote in pediatric poisonings? A1 - Frascogna,Nan, PY - 2007/5/15/pubmed PY - 2007/6/27/medline PY - 2007/5/15/entrez SP - 201 EP - 5 JF - Current opinion in pediatrics JO - Curr Opin Pediatr VL - 19 IS - 2 N2 - PURPOSE OF REVIEW: Ingestion of anticholinergic medications is common in pediatrics. Toxicity may result in symptoms such as severe agitation requiring physical restraint. Physostigmine, an antidote for anticholinergic poisoning, could be useful in this situation. Many physicians are hesitant to use physostigmine after case series suggested its use in tricyclic antidepressant overdose was associated with asystole. This paper reviews the anticholinergic toxidrome and pathophysiology, recent literature on the efficacy and toxicity of physostigmine, and its dosing, indications, and contraindications. RECENT FINDINGS: Recent articles suggest that toxicity associated with physostigmine consists mostly of seizures and cardiac arrhythmia, and occurs when used in the absence of anticholinergic symptoms. Despite potential complications, physostigmine has been shown to be useful in cases of confirmed anticholinergic poisoning by controlling agitation and reversing delirium, and appears to be safer and more effective than benzodiazepines in this situation. SUMMARY: In the proper clinical situation such as pure anticholinergic overdose with severe symptoms, physostigmine can be beneficial. The potential for side effects is not insignificant, and the antidote should be used with caution in any patient with unknown ingestions or those with cardiac conduction defects. More research is needed, especially involving children, before we will fully understand the indications and toxicities associated with physostigmine. SN - 1040-8703 UR - https://wwww.unboundmedicine.com/medline/citation/17496766/Physostigmine:_is_there_a_role_for_this_antidote_in_pediatric_poisonings L2 - https://doi.org/10.1097/MOP.0b013e32802c7be1 DB - PRIME DP - Unbound Medicine ER -