Two patients with coma, choreoathetoid movements, and myoclonus were found to be poisoned with tricyclic antidepressants. Physostigmine salicylate, a centrally active anticholinergic agent, promptly reversed the neurologic abnormalities. It appears to be the drug of choice in tricyclic antidepressant poisoning as well as in treating classical anticholinergic intoxication. It is relatively safe and can be used as a diagnostic test for suspected poisoning from these agents. These cases also support the cholinergic deficiency/dopaminergic excess hypothesis of chorea.
(JAMA 230:1405-1407, 1974)
Burks JS, Walker JE, Rumack BH, Ott JE. Tricyclic Antidepressant Poisoning: Reversal of Coma, Choreoathetosis, and Myoclonus by Physostigmine. JAMA. 1974;230(10):1405–1407. doi:10.1001/jama.1974.03240100023020
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