What reversible AChE inhibitor is utilized for treating atropine overdoses?

Physostigmine is the reversible acetylcholinesterase (AChE) inhibitor that is particularly effective in treating atropine overdoses. Atropine is an anticholinergic drug that counteracts the effects of acetylcholine, leading to symptoms such as tachycardia, dry mouth, and pupil dilation. By inhibiting acetylcholinesterase, physostigmine increases the levels of acetylcholine in the synaptic cleft, helping to restore cholinergic activity and counteract the effects of atropine.

The effectiveness of physostigmine in this context lies in its ability to penetrate the central nervous system, which is crucial for managing atropine overdoses—especially when central symptoms are present. In contrast, other reversible AChE inhibitors, while useful for other conditions like Alzheimer's disease, do not have the same level of efficacy for reversing anticholinergic toxicity due to their different pharmacokinetic profiles and mechanisms of action. For example, donepezil, rivastigmine, and galantamine are primarily used in the treatment of neurodegenerative diseases and are not indicated for managing acute atropine poisoning.