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Drug Shortage Updates: Physostigmine (2026)

Physostigmine has historically been the antidote of choice for anticholinergic toxicity-associated delirium. Due to a nationwide shortage of physostigmine, alternative treatment strategies may need to be considered in addition to benzodiazepines.

The Minnesota Regional Poison Center has developed guidance summarizing potential alternatives during the shortage, including rivastigmine and donepezil, with practical considerations for use.

Key Points

  • Rivastigmine (Exelon) may be considered in select patients with anticholinergic delirium, particularly:
    • Intubated anticholinergic patients to potentially help speed extubation
    • Patients who are awake, mildly agitated, and still able to take oral medications
  • Donepezil (Aricept) is not recommended at this time.

A comparison of physostigmine, oral rivastigmine, rivastigmine patch, and oral donepezil—including usual dosing, onset, duration, efficacy, and monitoring considerations—is available in the full guidance document.

View the full Physostigmine Shortage Guidance (PDF)

What Are Updates to Acetaminophen Management?

What Is a Poison?

  • A poison is any potentially harmful substance taken into, or applied to, the body.
  • Exposure can occur by ingestion, inhalation, injection, or through the skin or eyes.
  • Almost any substance may be poisonous if exposure occurs in excessive quantities.

When Should I Induce Vomiting?

  • You should always consult your physician or the Poison Center to determine if vomiting is necessary and safe.
  • Home remedies should never be used to induce vomiting, including syrup of ipecac, mustard, salt water, or placing fingers or objects in the throat.

What If I Suspect Someone Has Been Poisoned?

  • If you suspect you or someone else has been poisoned, call Poison Help at 1-800-222-1222.
  • The Poison Help number works anywhere in the United States. Specialists are available 24/7 to assess your situation and provide guidance.

Who Are the Poison Center’s Most Frequent Callers?

  • The most frequent callers are caregivers of children under 5 years old.

When Is the Poison Center the Busiest?

  • The busiest time of year is during the summer months, when children are more active indoors and outdoors.
  • The busiest time of day is typically in the evening, between dinner and bedtime.

What Are the Most Common Exposures?

  • The most common exposures involve medications that resemble candy or flavored drinks.
  • Young children commonly ingest cough and cold syrups, asthma medications, liquid acetaminophen (Tylenol), and antibiotics.

What Should I Do If My Pet Has Been Poisoned?

The Minnesota Poison Control System does not manage animal poisonings. Please contact your veterinarian or one of the resources below. A fee may apply. For more information, visit the ASPCA Animal Poison Control Center.

Need help accessing these materials? We are working to make all documents on this page accessible. If you need this information in another format, please call Poison Help at 1-800-222-1222.