What is the first-line treatment for antihistamine/anticholinergic overdose?

The first-line treatment for antihistamine or anticholinergic overdose is physostigmine. Physostigmine is a reversible inhibitor of the enzyme acetylcholinesterase, which leads to an increase in acetylcholine levels. In cases of anticholinergic toxicity, there is an imbalance due to excessive cholinergic activity being inhibited by the overdosed agent. Administering physostigmine can help counteract the effects of the anticholinergics, particularly in managing symptoms like confusion, delirium, or severe anticholinergic effects such as tachycardia and dry mucous membranes.

This treatment is particularly useful in cases where the patient exhibits significant central anticholinergic symptoms. However, it is important to consider the patient’s clinical condition since physostigmine may also have risks, including the potential to induce seizures, especially if given too quickly.

Other options may be useful in different contexts of poisoning or overdose but are not first-line treatments for antihistamine or anticholinergic overdose. For example, activated charcoal can be used to reduce drug absorption in certain situations, but its efficacy depends on timing and is not specific to this type of poisoning. Atropine is used to treat br