Tropatepine poisoning and management: a series of 458 cases
Year: 2026
Type: article
Study design: Observational Study
Abstract: Introduction Tropatepine is an antiparkinsonian drug that can be associated with antimuscarinic delirium in overdose. Two acetylcholinesterase inhibitors, neostigmine and physostigmine, are available for the management of tropatepine poisoning. The aim of this study is to describe a series of tropatepine poisonings and to compare the management of patients.Methods This epidemiological, retrospective, multicentre study reviewed tropatepine intoxications reported to French poison centres from 1 January 2000 to 13 July 2023. The relationship between reduction in central antimuscarinic signs and associated risk factors was assessed by univariate and multivariate logistic regression.Results A total of 458 cases of tropatepine poisoning were included. Peripheral and central antimuscarinic signs were observed in 214 (46.7%) and 102 patients (22.3%), respectively. For patients who ingested tropatepine alone (n = 94), 29 (30.8%) showed agitation or delirium. A reported median ingested dose of 270 mg of tropatepine was associated with the onset of central and peripheral antimuscarinic signs, compared with 100 mg for peripheral signs alone (P = 0.0012). The median (IQR) duration of central antimuscarinic signs was 24 h (12–48 h). Agitation was treated by neostigmine and physostigmine in 25 and 13 patients, respectively. In 16 (76%) patients treated with neostigmine, there was no improvement in central signs, whereas 13 (100%) patients responded favorably to physostigmine. After adjustment for ingested dose, the complete resolution of central antimuscarinic signs was significantly higher in patients treated with physostigmine than with neostigmine (odds ratio 6.61; 95% CI: 1.00–44.94]; P = 0.0499).Discussion Due to its long elimination half-life, tropatepine poisoning is frequently associated with a severe and prolonged antimuscarinic syndrome. Caring for these agitated patients requires substantial input from nursing staff.Conclusions Physostigmine is still little used but appears to be effective in controlling the central antimuscarinic syndrome induced by tropatepine.
Source: Clinical Toxicology
Authors: Emilie Tireau, Alexis Descatha, French PCC Research group, Marie Deguigne, Nathalie Paret, Cécile Chevallier, Anthony Facile, Aurore Czerwiec, Ramy Azzouz, Anne Garat, Patrick Nisse, Jérémy Lecot, Morgane Cellier, Philippe Chauveau, Géraldine Meyer, Nicolas Delcourt, Fanny Pelissier, Florent Battefort, Alix-Marie Pouget, Camille Paradis, Coralie Braganca, Audrey Nardon, Ingrid Blanc-Brisset, Magali Labadie, Romain Torrents, Julien Reynoard, Nicolas Simon, Céline Moulut, Marion Evrard, Emmanuel Puskarczyk, Weniko Care, Hervé Laborde-Casterot, Jérôme Langrand, Dominique Vodovar
Institutions: Centre Hospitalier Universitaire d'Angers, Hôpitaux Universitaires Grand Ouest, Inserm, École des Hautes Études en Santé Publique, Donald & Barbara Zucker School of Medicine at Hofstra/Northwell, Institut de Recherche en Santé, Environnement et Travail, Université de Rennes, Hospices Civils de Lyon, Centre Hospitalier Universitaire de Lille, Hôpital Purpan, Hôpital Pellegrin, Hôpital Sainte-Marguerite, Centre Hospitalier Régional et Universitaire de Nancy, Assistance Publique – Hôpitaux de Paris, Hôpital Fernand-Widal
Language: English
Subfield: Emergency Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W7124861465