Central anticholinergic syndrome from orphenadrine in a 3 year old

Orphenadrine (N,N-dimethyl-2 (o-methyl-alpha-phenylbenzyloxy)ethylamine) is an analog of diphenhydramine,vith central and peripheral anticholinergic p roperties. It is commonly prescribed both as a muscle relaxant and as an ad junct to antipsychotic medications to prevent parkinsonism, We report a cas e of orphenadrine poisoning in a 3-year-old boy following ingestion of no m ore than two 100-mg tablets. Central anticholinergic toxicity was prominent , manifested by hallucinations and severe agitation. Orphenadrine can cause profound toxicity in children after ingestion of small doses, and should b e considered as a potential cause for acute delirium in childhood.