Tropatepine poisoning and management: a series of 458 cases
Abstract
Introduction: Tropatepine is an antiparkinsonian drug that can be associated with antimuscarinic delirium in overdose. Two acetylcholinesterase inhibitors, neostigmine and physostigmine, are available for the management of tropatepine poisoning. The aim of this study is to describe a series of tropatepine poisonings and to compare the management of patients. Methods: This epidemiological, retrospective, multicentre study reviewed tropatepine intoxications reported to French poison centres from 1 January 2000 to 13 July 2023. The relationship between reduction in central antimuscarinic signs and associated risk factors was assessed by univariate and multivariate logistic regression. Results: A total of 458 cases of tropatepine poisoning were included. Peripheral and central antimuscarinic signs were observed in 214 (46.7%) and 102 patients (22.3%), respectively. For patients who ingested tropatepine alone (n = 94), 29 (30.8%) showed agitation or delirium. A reported median ingested dose of 270 mg of tropatepine was associated with the onset of central and peripheral antimuscarinic signs, compared with 100 mg for peripheral signs alone (P = 0.0012). The median (IQR) duration of central antimuscarinic signs was 24 h (12-48 h). Agitation was treated by neostigmine and physostigmine in 25 and 13 patients, respectively. In 16 (76%) patients treated with neostigmine, there was no improvement in central signs, whereas 13 (100%) patients responded favorably to physostigmine. After adjustment for ingested dose, the complete resolution of central antimuscarinic signs was significantly higher in patients treated with physostigmine than with neostigmine (odds ratio 6.61; 95% CI: 1.00-44.94]; P = 0.0499). Discussion: Due to its long elimination half-life, tropatepine poisoning is frequently associated with a severe and prolonged antimuscarinic syndrome. Caring for these agitated patients requires substantial input from nursing staff. Conclusions: Physostigmine is still little used but appears to be effective in controlling the central antimuscarinic syndrome induced by tropatepine.
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BibTeX
@article{tireau2026tropatepine,
title = {{Tropatepine poisoning and management: a series of 458 cases}},
author = {Emilie Tireau and Alexis Descatha and Marie Deguigne and Nathalie Paret and Cécile Chevallier and Anthony Facile and Aurore Czerwiec and Ramy Azzouz and Patrick Nisse and Anne Garat and Jérémy Lecot and Morgane Cellier and Philippe Chauveau and Géraldine Meyer-Dilhet and Nicolas Delcourt and Fanny Pelissier and Alix-Marie Pouget and Florent Battefort and Camille Paradis and Coralie Bragança and Audrey Nardon and Ingrid Blanc-Brisset and Magali Labadie and Romain Torrents and Julien Reynoard and Nicolas Simon and Céline Moulut and Marion Evrard and Emmanuel Puskarczyk and Weniko Care and Hervé Laborde-Castérot and Jérôme Langrand and Dominique Vodovar},
journal = {Clinical Toxicology},
year = {2026},
month = sep,
doi = {10.1080/15563650.2025.2605131},
url = {https://hal.science/hal-05493429v1},
note = {CC BY-NC 4.0},
}
RIS
TY - JOUR
TI - Tropatepine poisoning and management: a series of 458 cases
AU - Emilie Tireau
AU - Alexis Descatha
AU - Marie Deguigne
AU - Nathalie Paret
AU - Cécile Chevallier
AU - Anthony Facile
AU - Aurore Czerwiec
AU - Ramy Azzouz
AU - Patrick Nisse
AU - Anne Garat
AU - Jérémy Lecot
AU - Morgane Cellier
AU - Philippe Chauveau
AU - Géraldine Meyer-Dilhet
AU - Nicolas Delcourt
AU - Fanny Pelissier
AU - Alix-Marie Pouget
AU - Florent Battefort
AU - Camille Paradis
AU - Coralie Bragança
AU - Audrey Nardon
AU - Ingrid Blanc-Brisset
AU - Magali Labadie
AU - Romain Torrents
AU - Julien Reynoard
AU - Nicolas Simon
AU - Céline Moulut
AU - Marion Evrard
AU - Emmanuel Puskarczyk
AU - Weniko Care
AU - Hervé Laborde-Castérot
AU - Jérôme Langrand
AU - Dominique Vodovar
PY - 2026
DA - 2026/09/07
JO - Clinical Toxicology
DO - 10.1080/15563650.2025.2605131
UR - https://hal.science/hal-05493429v1
AB - Introduction: Tropatepine is an antiparkinsonian drug that can be associated with antimuscarinic delirium in overdose. Two acetylcholinesterase inhibitors, neostigmine and physostigmine, are available for the management of tropatepine poisoning. The aim of this study is to describe a series of tropatepine poisonings and to compare the management of patients. Methods: This epidemiological, retrospective, multicentre study reviewed tropatepine intoxications reported to French poison centres from 1 January 2000 to 13 July 2023. The relationship between reduction in central antimuscarinic signs and associated risk factors was assessed by univariate and multivariate logistic regression. Results: A total of 458 cases of tropatepine poisoning were included. Peripheral and central antimuscarinic signs were observed in 214 (46.7%) and 102 patients (22.3%), respectively. For patients who ingested tropatepine alone (n = 94), 29 (30.8%) showed agitation or delirium. A reported median ingested dose of 270 mg of tropatepine was associated with the onset of central and peripheral antimuscarinic signs, compared with 100 mg for peripheral signs alone (P = 0.0012). The median (IQR) duration of central antimuscarinic signs was 24 h (12-48 h). Agitation was treated by neostigmine and physostigmine in 25 and 13 patients, respectively. In 16 (76%) patients treated with neostigmine, there was no improvement in central signs, whereas 13 (100%) patients responded favorably to physostigmine. After adjustment for ingested dose, the complete resolution of central antimuscarinic signs was significantly higher in patients treated with physostigmine than with neostigmine (odds ratio 6.61; 95% CI: 1.00-44.94]; P = 0.0499). Discussion: Due to its long elimination half-life, tropatepine poisoning is frequently associated with a severe and prolonged antimuscarinic syndrome. Caring for these agitated patients requires substantial input from nursing staff. Conclusions: Physostigmine is still little used but appears to be effective in controlling the central antimuscarinic syndrome induced by tropatepine.
SN - 1556-3650
SN - 1556-9519
ER -