Suchard Jeffrey R
Department of Emergency Medicine, University of California Irvine Medical Center, Orange, California, USA.
J Emerg Med. 2003 Aug;25(2):185-91. doi: 10.1016/s0736-4679(03)00169-0.
Ingestion of cyclic antidepressant medications or prolongation of the electrocardiographic QRS interval are commonly considered as contraindications to the use of physostigmine as an antidote for antimuscarinic toxicity. This dictum seems to stem from a few well-publicized cases in which administration of physostigmine was temporally associated with the development of asystole. Before the report of these cases, physostigmine was more frequently used and had been considered a first-line antidote for both the neurologic and cardiac toxic effects of cyclic antidepressant overdose. This apparent inconsistency, and a resurgence of interest in physostigmine as an antidote, begs the question of the appropriateness of this drug's contraindication in all cyclic antidepressant ingestions. Review of the published clinical and experimental evidence provides little support for the clinical utility of using electrocardiographic criteria or the ingestion of cyclic antidepressants as contraindications to the use of physostigmine.
摄入环状抗抑郁药或心电图QRS间期延长通常被视为使用毒扁豆碱作为抗毒蕈碱中毒解毒剂的禁忌证。这一准则似乎源于一些广为人知的病例，在这些病例中，毒扁豆碱的使用与心搏停止的发生在时间上相关。在这些病例报告之前，毒扁豆碱使用更为频繁，并且被认为是环状抗抑郁药过量所致神经和心脏毒性作用的一线解毒剂。这种明显的矛盾，以及对毒扁豆碱作为解毒剂兴趣的再度兴起，引发了关于在所有环状抗抑郁药摄入情况下该药物禁忌证是否恰当的问题。对已发表的临床和实验证据的回顾几乎没有为将心电图标准或环状抗抑郁药的摄入作为毒扁豆碱使用的禁忌证的临床实用性提供支持。
