ReviewBritish journal of clinical pharmacology2016
Pharmacological management of anticholinergic delirium - theory, evidence and practice.
Review in British journal of clinical pharmacology, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 53 papers, 2 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
53 citing papers in PubMed, 2 syntheses or guidelines pooled it, 141 citations in OpenAlex.
- Pooled it
- Associations Between Anticholinergic Medication Exposure and Adverse Health Outcomes in Older People with Frailty: A Systematic Review and Meta-analysis.Drugs - real world outcomes · 2021Pooled it
- Pimavanserin for Parkinson's Disease psychosis: Effects stratified by baseline cognition and use of cognitive-enhancing medications.Movement disorders : official journal of the Movement Disorder Society · 2018Trial
- [Treatment of delirium with psychotropic drugs-update 2026].Zeitschrift fur Gerontologie und Geriatrie · 2026Review
- Toxidromes.Nature reviews. Disease primers · 2026Review
- Toward a Pluralistic Model for the Schizophrenia Spectrum-Dopamine and Beyond.JAMA psychiatry · 2026Review
- From Cholinergic Crisis to Anticholinergic Delirium: When the Antidote Mimics the Poison.Cureus · 2026Article
- The central cholinergic system as a therapeutic target in Parkinson's disease.Journal of Parkinson's disease · 2026Review
- Effects of Nonpharmacological and Nonsurgical Intervention for Lower Urinary Tract Symptoms in Parkinson's Disease: A Systematic Review and Meta-analysis.European urology open science · 2026Review
- Antimuscarinic Toxicity Safely Managed with High-Dose Transdermal Rivastigmine: A Case Report.Clinical practice and cases in emergency medicine · 2026Article
- Pharmacokinetics of Double-Layer Patches With Microneedles Containing Procyclidine and Rivastigmine in Guinea Pigs.Basic & clinical pharmacology & toxicology · 2025Article
- A Review of Non-Cardiac Complications of General Anesthesia: The Current State of Knowledge.Medical science monitor : international medical journal of experimental and clinical research · 2025Review
- Case Report: Atropine-induced delirium in a dog.Frontiers in veterinary science · 2025Article
- Anticholinergic burden and clinical outcomes among older adults admitted in a tertiary hospital: a prospective cohort study.PloS one · 2025Article
- Article
- Safety of Physostigmine for Pediatric Antimuscarinic Poisoning.Journal of medical toxicology : official journal of the American College of Medical Toxicology · 2024Article
- Common molecular and pathophysiological underpinnings of delirium and Alzheimer's disease: molecular signatures and therapeutic indications.BMC geriatrics · 2024Article
- An Evidence-Based Update on Anticholinergic Use for Drug-Induced Movement Disorders.CNS drugs · 2024Review
- Decoding the Neurological Sequelae of General Anesthesia: A Review.Medical science monitor : international medical journal of experimental and clinical research · 2024Review
- Predictors of postoperative delirium in paediatric patients undergoing surgery under general anaesthesia at Amhara Regional State Tertiary Hospitals: a multicenter prospective study.Frontiers in pediatrics · 2024Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
2 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
The spectrum of anticholinergic delirium is a common complication following drug overdose. Patients with severe toxicity can have significant distress and behavioural problems that often require pharmacological management. Cholinesterase inhibitors, such as physostigmine, are effective but widespread use has been limited by concerns about safety, optimal dosing and variable supply. Case series support efficacy in reversal of anticholinergic delirium. However doses vary widely and higher doses commonly lead to cholinergic toxicity. Seizures are reported in up to 2.5% of patients and occasional cardiotoxic effects are also recorded. This article reviews the serendipitous path whereby physostigmine evolved into the preferred anticholinesterase antidote largely without any research to indicate the optimal dosing strategy. Adverse events observed in case series should be considered in the context of pharmacokinetic/pharmacodynamic studies of physostigmine which suggest a much longer latency before the maximal increase in brain acetylcholine than had been previously assumed. This would favour protocols that use lower doses and longer re-dosing intervals. We propose based on the evidence reviewed that the use of cholinesterase inhibitors should be considered in anticholinergic delirium that has not responded to non-pharmacological delirium management. The optimal risk/benefit would be with a titrated dose of 0.5 to 1 mg physostigmine (0.01-0.02 mg kg(-1) in children) with a minimum delay of 10-15 min before re-dosing. Slower onset and longer acting agents such as rivastigmine would also be logical but more research is needed to guide the appropriate dose in this setting.
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What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.