Amanita mushrooms have strong anticholinergic effects due to their concentration of ibotenic acid, muscazone, and muscimol. Clinically, intoxication takes the form of agitation, muscle spasms, ataxia, mydriasis, and even convulsions. Additional indole compounds may account for the hallucinosis that is often seen with intoxication. The genera Inocybe and Clitocybe contain muscarine and cause cholinergic excitation at all parasympathetic nerve endings except those of the neuromuscular junctions and nicotinic sites. Coprius atramentarius, or Inky Cap, is a common mushroom that is generally considered edible. Its consumption in combination with alcohol, however, results in a severe toxic reaction similar to that seen with disulfiram. The syndrome includes facial flushing, paresthesias, and severe nausea and vomiting. The responsible toxin is coprine, which acts to increase acetaldehyde blood levels.
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