Rivastigmine as an alternative in physostigmine shortage for anticholinergic toxicity treatment

Anticholinergic toxicity, a medical emergency characterized by symptoms such as dry mouth, blurred vision, severe delirium, and tachycardia, necessitates prompt and effective intervention. The traditional go-to treatment has been physostigmine, a reversible cholinesterase inhibitor known for its ability to cross the blood-brain barrier (BBB). However, the occasional scarcity of physostigmine has led healthcare professionals to consider alternative treatments, with rivastigmine emerging as a potential candidate (1). This article delves into the feasibility of using rivastigmine as a substitute, focusing on its ability to penetrate the brain and its effectiveness in managing anticholinergic toxicity.