1c:I[419806,["/_next/static/chunks/bb923814e1f4d2e9.js","/_next/static/chunks/dd3ee9f5b7716ca6.js","/_next/static/chunks/4204a0ae82542ca8.js","/_next/static/chunks/30036bedc5269936.js","/_next/static/chunks/6e1aa89a642f40be.js","/_next/static/chunks/cd5e572bc3e4eb92.js","/_next/static/chunks/8ffd0b71567920d8.js","/_next/static/chunks/67ea6dfd21f16c5f.js","/_next/static/chunks/24eb4379f68013fd.js","/_next/static/chunks/b8cd775ffdf935bd.js","/_next/static/chunks/983103cd9eb7b428.js","/_next/static/chunks/d4ac9dcf27f6ff52.js","/_next/static/chunks/294b9525248c8e5f.js"],"default"] 1d:T42c,THIS article illustrates the rapid reversal of coma due to amitriptyline hydrochloride overdose by the administration of physostigmine salicylate. Physostigmine is the only commonly used specific cholinesterase inhibitor that readily penetrates the blood brain barrier.¹ Slovis et al²reported that physostigmine rapidly restored alertness and reversed tachycardia in four patients with amitriptyline intoxication. Rumack³reported the successful use of physostigmine to treat children who became intoxicated by various agents with anticholinergic properties as well as the tricyclic antidepressants.

Report of Cases

Case 1.—

A 27-year-old woman was admitted in coma to Martin Army Hospital on April 2, 1974. History provided by a friend indicated that after an alleged altercation with her estranged husband, the patient ingested 20 amitriptyline hydrochloride tablets (50 mg) and about 20 diazepam tablets (5 mg). When discovered by a neighbor, approximately 10 to 12 hours later, she could not be aroused. When seen1e:T41c,

To the Editor.—

Physostigmine is an effective antidote to the central effects of scopolamine and a variety of other drugs that may have anticholinergic activity, eg, tricyclic antidepressants and antihistamines.¹ Animal studies have suggested that physostigmine will reverse sedation from the butyrophenone haloperidol.²In man, there are indications of its usefulness in antagonizing phenothiazine- and diazepam-induced coma.³ The following case history describes the use of physostigmine in the reversal of sedation from the butyrophenone droperidol and diazepam without effecting narcotic analgesia.

Report of a Case.—

A healthy, but extremely anxious, 37-year-old man was scheduled to undergo right inguinal hernia repair. He was premedicated with morphine sulfate, 12 mg, diazepam, 10 mg, and atropine, 0.4 mg, one hour prior to surgery. In the operating room he was alert and cooperative but quite apprehensive. Anesthesia was induced with diazepam, 20 mg, and 5 ml of a mixture of droperidol

	Year	Citations

References