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Antimuscarinic Toxicity Safely Managed with High-Dose Transdermal Rivastigmine: A Case Report

Year: 2026

Type: article

Abstract: INTRODUCTION: Antimuscarinic toxicity, which can cause delirium and unsafe behavior, may result from an adverse effect of prescribed medications or from non-medical substance use. Physostigmine shortages have prompted use of transdermal rivastigmine for management of antimuscarinic toxicity; however, symptom control is equivocal at standard dosing. CASE REPORT: A patient with antimuscarinic toxicity was treated with physostigmine and transitioned to 26.6 milligrams/24 hours transdermal rivastigmine for sustained symptom control. He experienced no adverse effects and tolerated floor admission. DISCUSSION: There is mechanistic plausibility supporting safe, sustained control of antimuscarinic toxicity with high-dose transdermal rivastigmine. Central distribution is more rapid than serum distribution and higher doses correlate with a shorter time to peak concentration.

Source: Clinical Practice and Cases in Emergency Medicine

DOI: 10.5811/cpcem.49089

Authors: Christopher James Watson, Emilie M. Burrill, William S. Jaffee

Institutions: Tufts University, Maine Medical Center, Maine Medical Center

Language: English

Topic: Poisoning and overdose treatments

Subfield: Emergency Medicine

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $500