Anticholinergic toxidrome
Central and peripheral antimuscarinic features, the common Australian culprits (sedating antihistamines, antipsychotics, tricyclics, Datura and Brugmansia), the ECG check before physostigmine, and the evidence for physostigmine and rivastigmine over sedation.
Tier 1Condition
Written with AI assistance and fact-checked against the sources below. For exam study, not clinical decisions. How notes are made
At a glance
- The anticholinergic toxidrome is antimuscarinic: blockade of muscarinic acetylcholine receptors in the brain and the parasympathetic nervous system.
- Delirium plus dry skin, big pupils, tachycardia, urinary retention and a silent abdomen.
- The main danger is agitation, with falls, hyperthermia, rhabdomyolysis and restraint injury. Death is rare unless the drug also blocks sodium channels.
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Sources
- Therapeutic Guidelines: Toxicology and Toxinology (December 2024 update)AU/NZTherapeutic Guidelines Limited, 2024
- Poisons Information Centre (13 11 26)AU/NZNSW Poisons Information Centre, Sydney Children's Hospitals Network
- Burns MJ, Linden CH, Graudins A, Brown RM, Fletcher KE. A comparison of physostigmine and benzodiazepines for the treatment of anticholinergic poisoning. Ann Emerg Med 2000;35:374-81Annals of Emergency Medicine, 2000
- Chiew AL, Holford AG, Chan BSH, Isoardi KZ. Rivastigmine for the management of anticholinergic delirium. Clin Toxicol 2024;62:82-7AU/NZClinical Toxicology, 2024
- Fotheringham S, Buckley NA, Bradshaw C, Dawson A. Post-injection delirium/sedation syndrome from long-acting olanzapine intramuscular injection is rapidly reversed with physostigmine and rivastigmine. Clin Toxicol 2025;63:684-6AU/NZClinical Toxicology, 2025
- Last updated
- 14 November 2026
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