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![]() 1 It was also during the 1970s that it was suggested as a potentially life-saving antidote in tricyclic antidepressant (TCA) toxicity. Physostigmine was used extensively in the 1960s and ’70s in the treatment of undifferentiated delirium. Consequently, physostigmine is effective in reversing the peripheral and central effects of anticholinergic toxicity. Physostigmine is a carbamate acetylcholinesterase inhibitor that is readily capable of crossing the blood-brain barrier due to its tertiary amine properties. ![]() Despite evidence that physostigmine is undeniably effective in treating the symptoms of confirmed anticholinergic poisoning, its use has plummeted since the early 1980s. Physostigmine became one of a handful of drugs that don’t get the respect they deserve. Yet a growing amount of more current evidence suggests the toxicity profile associated with physostigmine is misunderstood and occurs when used inappropriately. 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