While antipsychotic medications have long been associated with anticholinergic effects, asenapine has been purported to have no capacity for muscarinic cholinergic antagonism based on in vitro studies. Research in rat brain tissue has yielded different results, with one study finding more cholinergic M1-5 binding in the medial prefrontal cortex, dorsolateral frontal cortex and hippocampal CA1 and CA3 areas than would be predicted from in vitro findings. Moreover, it is structurally similar to other anticholinergic antipsychotics such as loxapine and, to a lesser degree, quetiapine, olanzapine and clozapine. This case report describes the anticholinergic toxidrome in a patient treated with benztropine and paroxetine at stable doses, with the emergence of the toxidrome after upward titration of asenapine. A broad differential was considered. With further consideration of the history, time-course, clinical features and physical examination, the presentation is most indicative of the anticholinergic toxidrome. Although not employed, physostigmine, the antidote for anticholinergic delirium, could help to differentiate this toxidrome and serve as a diagnostic and therapeutic intervention. We have presented this case to highlight the importance for clinicians to integrate history and bedside examination data with principles of pharmacology. In particular, asenapine should be added to the list of compounds with recognized anticholinergic potential.

中文翻译：

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病例报告：阿塞那平和抗胆碱能毒性。

虽然抗精神病药物长期以来一直与抗胆碱能作用有关，但根据体外研究，据称阿塞那平没有毒蕈碱胆碱能拮抗作用。对大鼠脑组织的研究产生了不同的结果，一项研究发现内侧前额叶皮层、背外侧额叶皮层和海马 CA1 和 CA3 区域的胆碱能 M1-5 结合比体外研究结果预测的要多。此外，它在结构上类似于其他抗胆碱能抗精神病药，例如洛沙平，以及在较小程度上与喹硫平、奥氮平和氯氮平相似。本病例报告描述了使用稳定剂量苯甲托品和帕罗西汀治疗的患者的抗胆碱能中毒症状，在阿塞那平向上滴定后出现该中毒症状。考虑了广泛的差异。进一步考虑病史、时间进程、临床特征和体格检查，该表现最能表明抗胆碱能中毒症状。虽然未使用，但毒扁豆碱是抗胆碱能谵妄的解毒剂，可以帮助区分这种毒株并作为诊断和治疗干预措施。我们提出这个案例是为了强调临床医生将病史和床边检查数据与药理学原理相结合的重要性。特别是，应将阿塞那平添加到具有公认抗胆碱能潜力的化合物列表中。可以帮助区分这种毒物组并作为诊断和治疗干预措施。我们提出这个案例是为了强调临床医生将病史和床边检查数据与药理学原理相结合的重要性。特别是，应将阿塞那平添加到具有公认抗胆碱能潜力的化合物列表中。可以帮助区分这种毒物组并作为诊断和治疗干预措施。我们提出这个案例是为了强调临床医生将病史和床边检查数据与药理学原理相结合的重要性。特别是，应将阿塞那平添加到具有公认抗胆碱能潜力的化合物列表中。