A randomized trial comparing physostigmine vs lorazepam for treatment of antimuscarinic (anticholinergic) toxidrome
| Autor: | George Sam Wang, Kennon Heard, Keith A. Baker, Gregory C. Janis, Jan Leonard, Rakesh D. Mistry, Patrick Ng |
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| Rok vydání: | 2020 |
| Předmět: |
Male
Physostigmine Adolescent medicine.drug_class Muscarinic Antagonists Lorazepam Toxicology law.invention 03 medical and health sciences 0302 clinical medicine Double-Blind Method Randomized controlled trial law mental disorders Anticholinergic medicine Humans 030212 general & internal medicine Toxidrome Antimuscarinic Agent business.industry Delirium 030208 emergency & critical care medicine General Medicine Length of Stay medicine.disease Diphenhydramine Treatment Outcome Anti-Anxiety Agents Anesthesia Toxicity Female medicine.symptom business Akathisia Drug-Induced medicine.drug |
| Zdroj: | Clinical Toxicology. 59:698-704 |
| ISSN: | 1556-9519 1556-3650 |
| DOI: | 10.1080/15563650.2020.1854281 |
| Popis: | Toxicity from antimuscarinic agents precipitates a constellation of signs and symptoms; two of the most significant are agitation and delirium. Benzodiazepines are commonly used for treatment; physostigmine is also effective but is underutilized due to concerns for safety and short duration of action. The objective of this study was to compare lorazepam to physostigmine for the treatment of antimuscarinic delirium and agitation.This was a blinded, randomized clinical trial in patients presenting for antimuscarinic toxidrome. Inclusion criteria were: ≥10-18 years old, at least one central and two peripheral antimuscarinic symptoms, delirium and moderate agitation. Subjects were randomized to either (1) lorazepam bolus (0.05 mg/kg) followed by a 4-h normal saline infusion, or (2) physostigmine 0.02 mg/kg bolus followed by a 4-h physostigmine infusion (0.02 mg/kg/h). Primary outcomes were the control of delirium and agitation after bolus and during the infusion.Ten (53%) subjects were enrolled in the lorazepam arm, 9 (47%) in the physostigmine arm. Diphenhydramine was the most common agent ingested (16, 84%). Fewer patients receiving physostigmine had delirium after the initial bolus (44% vs 100%,Physostigmine was superior to lorazepam in controlling antimuscarinic delirium and agitation after bolus dosing, and control of delirium after a 4-h infusion. There were no serious adverse events in either treatment arm. Physostigmine bolus and infusion should be considered in adolescent patients with significant delirium and agitation from antimuscarinic agents. |
| Databáze: | OpenAIRE |
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