Letter: Physostigmine and anticholinergic poisoning.

Abstract

To the Editor.— I read with interest the article by Newton on the use of physostigmine salicylate in the treatment of tricyclic antidepressant poisoning (231:941, 1975). Newton concludes that in his series at a regional poisoning treatment center, over-dosage with these drugs is a benign event and that the use of a specific antidote was not indicated in its treatment. His report, nevertheless, documents the rapid reversal of coma by physostigmine, confirming our results (230: 1433, 1974) and the results of others. We would object to Newton's conclusions for the following reasons: (1) Although there is a low incidence of fatality in this overdose situation, fatalities do occur and cannot be ignored. These fatalities are frequently in children or young adults and are due to cardiac arrhythmias or complications of coma, such as pneumonia. (2) The population reported in Newon's series includes no serious arrhythmias and no children, and no