Anticholinergic Poisoning

Anticholinergic Poisoning is a topic covered in the 5-Minute Emergency Consult.

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  • Central and peripheral cholinergic blockade
  • Depending on the drug involved, antagonism occurs at muscarinic (most common), nicotinic, or both receptors.
  • Onset of activity: 15–30 min after ingestion
  • Duration of effect: 2–24 hr


  • Many drugs contain anticholinergic properties:
    • Mild at therapeutic doses
    • Life threatening in overdose
  • Anticholinergic substances:
    • Antihistamines
    • Belladonna alkaloids and synthetic congeners
    • Antiparkinsonian drugs
    • Cyclic antidepressants
    • Antipsychotics (neuroleptics)
    • Mydriatics
    • Skeletal muscle relaxants (orphenadrine, cyclobenzaprine)
    • Antispasmodics
    • Mushrooms—Amanita muscaria, Amanita pantherina
    • Plants—deadly nightshade, mandrake, henbane
    • Jimson weed—smoked or ingested

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