Procyclidine overdose induced central and peripheral anti-cholinergic toxicity

ABSTRACTProcyclidine is an anticholinergic agent that blocks excess acetylcholine at cerebral synapses. We describe central and peripheral anticholinergic toxicity in a 34-year-old male after 60 tablets of procyclidine (300 mg). He displayed acute agitation, tachycardia, mydriasis, dry mucous membranes, and urinary retention. Physostigmine is the antidote of anticholinergic toxicity but is unavailable in Qatar. He received supportive care in the ICU with repeated doses of diazepam and lorazepam. He improved sufficiently in three days to transfer to a psychiatric facility. We discuss and compare the roles of physostigmine and benzodiazeines in treating anticholinergic toxicity.