UNASSIGNED: The spectrum of anticholinergic @entity933 is a common complication following drug @entity1445 . @entity1 with severe @entity137 can have significant distress and behavioural problems that often require pharmacological management. Cholinesterase inhibitors, such as @entity2607 , 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 @entity933 . However doses vary widely and higher doses commonly lead to cholinergic @entity137 . @entity410 are reported in up to 2.5% of @entity1 and occasional @entity1370 effects are also recorded. This article reviews the serendipitous path whereby @entity2607 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 @entity2607 which suggest a much longer latency before the maximal increase in brain @entity934 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 @entity933 that has not responded to non-pharmacological @entity933 management. The optimal risk/benefit would be with a titrated dose of 0.5 to 1  mg @entity2607 (0.01-0.02  mg  kg(-1) in @entity1 ) with a minimum delay of 10-15  min before re-dosing. Slower onset and longer acting agents such as @entity11544 would also be logical but more research is needed to guide the appropriate dose in this setting.

Pharmacological management of anticholinergic XXXX - theory, evidence and practice.

@entity1 :: ('9606', 'Species') :: ['children', 'Patients', 'patients'] @entity410 :: ('MESH:D012640', 'Disease') :: ['Seizures'] @entity137 :: ('MESH:D064420', 'Disease') :: ['toxicity'] @entity1370 :: ('MESH:D066126', 'Disease') :: ['cardiotoxic'] @entity2607 :: ('MESH:D010830', 'Chemical') :: ['physostigmine'] @entity11544 :: ('MESH:C072506', 'Chemical') :: ['rivastigmine'] @entity933 :: ('MESH:D003693', 'Disease') :: ['delirium'] @entity1445 :: ('MESH:D062787', 'Disease') :: ['overdose'] @entity934 :: ('MESH:D000109', 'Chemical') :: ['acetylcholine']
@entity933 :: (MESH:D003693,Disease) :: ['delirium']
