Organophosphates (OP) and carbamates, despite structural differences, share potent cholinesterase inhibition, posing risks of severe cholinergic toxicity through various exposures. Global estimates indicate over 3 million annual exposures, causing up to 300,000 fatalities. This review explores their poisoning, emphasizing recent events like the Tokyo sarin attack and Novichok incidents. Organophosphorus compounds initiate toxic effects by inhibiting acetylcholinesterase (AChE), leading to cholinergic excess. Carbamates act as transient inhibitors, hydrolyzing within 48 hours. Clinical manifestations involve cholinergic excess, nicotinic effects, cardiac complications, respiratory failure, and delayed neuropathy. Management includes resuscitation, atropine, pralidoxime, seizure control, decontamination, and individualized approaches. Prognostication involves considering factors like the Glasgow Coma Score and specic OP agents. Ongoing research is crucial for rening diagnostic and therapeutic strategies, considering the diverse clinical responses and individualized care required for organophosphate poisoning.