Physostigmine..Thumbs Up

Some of the atypical antipsychotic agents – quetiapine (Seroquel), onlanzapine (Zyprexa), clozapine (Xlozaril) — have significant anticholinergic properties.The Am J Emerg Med in 2011 July 28 issue,reported three patients with quetiapine overdose and altered mental status who improved after being treated with the carbamate physostigmine, a cholinergic agent sometimes used to reverse anticholinergic toxicity.

The authors stress that since the duration of physostigmine’s effect is only 30 to 90 minutes (far shorter than the duration of quetiapine), patients should be observed carefully and not have their level of care downgraded until at least 4 hours after the last dose of physostigmine. They conclude that physicians should be aware of [the] association” between quetiapine overdose and improvement in GCS following physostigmine administration.

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