Rivastigmine to Prevent Recurrence of Antimuscarinic Delirium

Eligibility Criteria

• * 10 years of age or older
• * Diagnosis of antimuscarinic delirium by history and physical examination, in the opinion of the treating attending toxicologist.
• * Treatment with physostigmine according to the local standard of care is planned or has been administered by the treating attending toxicologist and is acceptable to the patient's primary attending physician and surrogate decision maker.
• * Antimuscarinic delirium is reasonably controlled after initial physostigmine treatment, as determined by treating toxicologist on bedside physical examination. (Patients may begin the screening and enrollment process prior to physostigmine administration, but will not undergo final initiation of study treatment until after response to physostigmine has been confirmed).
• * Age less than 10 years at time of enrollment
• * Surrogate decision maker not available to provide informed consent for enrollment.
• * Patient is pregnant or a ward of the state.
• * Inability to safely tolerate oral medication, in the judgement of the treating attending physician.
• * Evidence of significant risk for serious cardiac or neurologic sequelae of antimuscarinic poisoning:
• * Evidence of significant risk of adverse effect of AChE-I:
• 1. Ages 10-12: HR \<84 beats per minute 2. Ages 12-15: HR \<78 beats per minute 3. Ages 15-18: HR \<73 beats per minute b. Known or suspected seizure disorder. c. History of asthma or COPD or wheezing during index presentation d. Known or suspected physical obstruction of intestinal or urogenital tract i. Ileus and/or urinary retention due to antimuscarinic poisoning do not exclude patients from enrollment.
• * Any known allergy or intolerance to rivastigmine or other AChEI.
• * Failure to achieve reasonable initial control of antimuscarinic delirium after physostigmine administration, as assessed by treating toxicologist on bedside physical examination.