EMERGENCY CASEBOOK

Case of the month: Rivastigmine (Exelon^®) toxicity with evidence of respiratory depression

S Sener¹ and M Ozsarac²

¹ Attending Physician of Emergency Medicine, Department of Emergency Medicine, Akay Medical Center, Ankara, Turkey
² Attending Physician of Emergency Medicine, Department of Emergency Medicine, School of Medicine, Gazi University, Ankara, Turkey

Correspondence to:
Correspondence to:
Dr S Sener
Attending Physician of Emergency Medicine, Department of Emergency Medicine, Akay Medical Center, Buklum sokak no. 4, 06660 Kavaklidere, Ankara, Turkiye; ssener{at}tr.net

Rivastigmine, which has been approved by the US Food and Drugs Administration for the treatment of Alzheimer’s disease, is a non-competitive reversible inhibitor of acetylcholinesterase. We present a case of rivastigmine toxicity at a dose of 90 mg, with evidence of respiratory depression. To our knowledge, this case report provides evidence of the highest rivastigmine ingestion recorded (90 mg) that caused respiratory depression but requiring only supportive intervention without the need for ralidoxime. Emergency physicians should strongly consider cholinesterase inhibitor (rivastigmine, galantamine, and tacrine) ingestion in patients who present with short and temporary organophosphate-like toxidromes.

Abbreviations: AD, Alzheimer’s disease; ED, emergency department; EP, emergency physician

Keywords: rivastigmine; acetylcholinesterase inhibitor; toxicity; pralidoxime; Alzheimer’s disease

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