A recent letter to the editor described successful treatment of anticholinergic delirium (ACD) with this acetylcholinesterase inhibitor during a physostigmine drug shortage.
Rivastigmine. According to the cited reference, in a patient with severe ACD, “therapy with 1.5 mg rivastigmine po twice daily was started. This resulted in a rapid decline in agitation over the next 6 h, with return to normal behavior within 24 h.” The authors conclude, “oral rivastigmine is a useful treatment for ACD, given its long acting profile, specificity for the central nervous tissue, presumed less peripheral toxicity, better availability, and cost-effectiveness compared to standard therapy.”
Van Kernbeek MW, Ghesquiere M, Vanderbruggen N, et al. Rivastigmine for the treatment of anticholinergic delirium following severe procyclidine intoxication. Clin Toxicol (Phila). 2021 May; 59(5):447-448. doi: 10.1080/15563650.2020.1818768. Epub 2020 Sep 22.