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Physostigmine

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Critical Care Toxicology

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Abstract

Physostigmine salicylate (Antilirium®) is a short-acting, lipid-soluble, nonselective, carbamate cholinesterase (ChE) inhibitor used to increase acetylcholine (ACh) concentrations at cholinergic receptors and most commonly employed in the treatment of anticholinergic-induced delirium. Physostigmine was the first known anticholinesterase used by humans. The native Efik people of West Africa used dried, ripened Calabar beans () containing the alkaloid physostigmine in their “trial by ordeal” [1, 2]. First described in 1840, the Old Calabar “trial by ordeal” required an accused individual to consume 1–20 Calabar beans in various fashions. If the individual vomited (and thus cleared the gastric bean burden), he was deemed innocent; if emesis did not occur, a cholinergic crisis followed by death was considered a guilty verdict. Predictably, very few accused survived their ordeal [1].

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Authors and Affiliations

  1. Assistant Clinical Professor of Emergency Medicine, University of Colorado School of Medicine, Denver, CO, 80210, USA

    William J. Boroughf

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  1. William J. Boroughf
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Editors and Affiliations

  1. University of Colorado School of Medicine, Toxicology Associates, Denver, Colorado, USA

    Jeffrey Brent

  2. Office of New Drugs Drug Evaluation and Research, FDA, Silver Spring, Maryland, USA

    Keith Burkhart

  3. Clinical Toxicology, St Thomas' Hospital, London, United Kingdom

    Paul Dargan

  4. University of Colorado School of Medicine, Toxicology Associates, Denver, Colorado, USA

    Benjamin Hatten

  5. Med & Toxicological Intensive Care Unit, Lariboisière Hospital Paris-Diderot University, Paris, France

    Bruno Megarbane

  6. University of Colorado School of Medicine, Toxicology Associates, Denver, Colorado, USA

    Robert Palmer

Grading System for Levels of Evidence Supporting Recommendations in Critical Care Toxicology: 2nd Edition

Grading System for Levels of Evidence Supporting Recommendations in Critical Care Toxicology: 2nd Edition

  1. I.

    Evidence obtained from at least one properly randomized controlled trial.

  2. II-1.

    Evidence obtained from well-designed controlled trials without randomization.

  3. II-2.

    Evidence obtained from well-designed cohort or case–control analytic studies, preferably from more than one center or research group.

  4. II-3.

    Evidence obtained from multiple time series with or without the intervention. Dramatic results in uncontrolled experiments (such as the results of the introduction of penicillin treatment in the 1940s) could also be regarded as this type of evidence.

  5. III.

    Opinions of respected authorities, based on clinical experience, descriptive studies and case reports, or reports of expert committees.

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Boroughf, W.J. (2016). Physostigmine. In: Brent, J., Burkhart, K., Dargan, P., Hatten, B., Megarbane, B., Palmer, R. (eds) Critical Care Toxicology. Springer, Cham. https://doi.org/10.1007/978-3-319-20790-2_159-1

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