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Accidental acute clidinium toxicity
  1. S E Richardson,
  2. K Edwards
  1. Emergency Department, John Radcliffe Hospital, Oxford, UK
  1. Dr S E Richardson, Emergency Department, John Radcliffe Hospital, Headley Way, Oxford OX3 9DU, UK; serichardson{at}


Clidinium bromide (N-methyl-quinuclidinyl-benzylate) is a rarely used antimuscarinic drug that is marketed in combination with chlordiazepoxide as an antispasmodic for use in irritable bowel syndrome. A case is reported of an accidental staggered overdose of clidinium bromide 50 mg in a patient using illicit chlordiazepoxide. The presenting features were mildly dilated pupils and palpitation secondary to sinus tachycardia that persisted for 11 h after the time of first ingestion. Emergency physicians should be aware of the potential for antimuscarinic toxicity in patients using illicit chlordiazepoxide.

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  • Competing interests: None.

  • Patient consent: Obtained.