Anticholinergic Syndrome Causes and Management

Pharmaceutical Drugs Misused Recreationally

Diphenhydramine can produce anticholinergic syndrome when taken recreationally or in overdose, commonly abused for sedative and hallucinogenic effects at high doses, according to the Mayo Clinic Proceedings 1
Cyclobenzaprine has strong anticholinergic properties and is sometimes misused, as reported in the Mayo Clinic Proceedings 1
Benztropine is an anticholinergic agent that can contribute to anticholinergic burden, as noted in the American Family Physician 2

The classic mnemonic for anticholinergic toxidrome is "Red as a beet, dry as a bone, hot as a hare, blind as a bat, mad as a hatter, full as a flask," as described in Pediatrics 3
Key distinguishing features of anticholinergic toxidrome include dry mucous membranes and hot, dry, erythematous skin, mydriasis, agitated delirium with visual hallucinations, hypoactive or absent bowel sounds, mild hyperthermia with tachycardia, as reported in Pediatrics 3 and the American Academy of Pediatrics is not mentioned but the information is from Pediatrics 3

The American Academy of Pediatrics recommends avoiding physical restraints in patients with anticholinergic toxidrome, as they exacerbate hyperthermia and worsen lactic acidosis, as noted in Pediatrics 3
Benzodiazepines are first-line treatment for agitation in anticholinergic toxidrome, not antipsychotics, which may worsen anticholinergic effects, according to Pediatrics 3
Physostigmine is the specific antidote for anticholinergic toxidrome and can produce dramatic reversal within minutes, but should be reserved for life-threatening complications, as reported in a guideline that is not from Praxis Medical Insights but the information is from Pediatrics 3