Antidotes
Antidotes at MUH
Antidotes at CUH
Antidotes held at regional centres
These are the National Poisons Information Service recommended antidotes - May 2009
Link here for theh 2008 National Poisons Information Service (NPIS) Antidote booklet or www.poisons.ie
Agent / drug |
IPCS Classification |
Indications |
Presentation |
Comments |
Activated Charcoal |
Group: 2*, A1** |
Reduction absorption toxic substances by GI tract that are adsorbed by charcoal |
50g pack |
|
Atropine |
Group 1, A1 |
Organophosphates, Carbamates |
Injection 600mcg/ml; |
Use in cardiac arrest iwith ALS guidelines |
Benztropine |
Group 3 |
Acute dystonia |
Tablets 2mg; injection 2mg in 2ml |
|
Calcium gluconate |
Group 2, A1 |
Prevent transdermal adsorption of hydrofluoric acid |
Calcium gluconate gel 2.5% |
|
Dantrolene |
Group 1, A2 |
Drug-induced hyperthermia incl. neuroleptic malignant syndrome |
Tablets 25mg, 100mg; injection 20mg |
|
Desferrioxamin |
Group 1, B1 |
Toxicity with iron |
Injection 500mg |
|
Diazepam |
Group 1 and 3, A2 |
Mx convulsions, anxiety, agitation and hypertonia 20 to toxins, toxicity with organophosphates |
Tablets 2mg, 5mg, 10mg; injection (Diazemuls) 10mg/2ml; rectal solution 2.5mg, 5mg, 10mg tubes |
|
Dicobalt edetate |
Group 1, A1 |
Toxicity with cyanide |
300mg/20ml |
Confirm toxicity by measuring the serum cyanide concentration |
Dimercaprol |
Group 1, B3 |
Toxicity with arsenic; can be used in conjunction with EDTA in cases of severe toxicity with lead, particularly lead encephalopathy |
100mg/2ml |
Must be administered intramuscularly. Contains peanut oil as a solvent |
Dimeticone |
Group 2 |
Anti-foaming agent; for ingestion of products such as shampoos and soaps that may foam if aspirated |
|
|
Agent / drug |
IPCS Classification |
Indications |
Presentation |
Comments |
Droperidol |
None |
Agitated psychosis |
Injection 10mg/2ml; tablets 10mg |
May cause less pronounced depression of the cardiorespiratory system than conventional phenothiazines |
Ethanol |
Group 1, A1 |
Toxicity with methanol and ethylene glycol |
Dehydrated alcohol injection |
|
Flumazanil |
Group 1, B1 |
WITH CAUTION in cases of ISOLATED toxicity with benzodiazepines resulting in severe respiratory and central nervous system depression; then only if supportive measures have failed |
Injection 500mcg/5ml |
Contraindicated
in : |
Agent / drug |
IPCS Classification |
Indications |
Presentation |
Comments |
Folinic acid |
Group 1, B1 |
Toxicity with folinic acid antagonists; toxicity with methanol |
Injection 15mg |
|
Fosphenytoin |
None |
Status epilepticus |
750mg/10ml (75mg/ml = phenytoin 50mg/ml) |
Less reactions at the IV site than phenytoin; hypotension, VF, asystole, bradycardia and heart block reported |
Glucagon |
Goup1, A1 |
Toxicity with Β-blockers |
1mg |
Consider in toxicity with Ca++ channel blockers and other agents that cause myocardial depression. Seek advice from NPIS |
Isoprenaline |
Group 1, A1 |
Toxicity with Β- blockers |
Injection 200mcg/10ml; IV infusion for dilution 1mg/ml |
|
Lorazepam |
None |
First line therapy in status epilepticus |
Injection 4mg/ml; tablets 1mg, 2.5mg |
Long half life compared with diazepam |
Mg2+ hydroxide |
Group2, B3 |
solution for whole bowel irrigation |
|
|
Methionine |
Group 1, B1 |
Toxicity with paracetamol |
Tablets 250mg |
Useful in anaphylactoid reactions to n-acetylcystene but adsorbed by activated charcoal |
Agent / drug |
IPCS Classification |
Indications |
Presentation |
Comments |
Methylene blue |
Group 1, A1 |
Iatrogenic methaemaglobinaemia |
100mg/10ml |
|
N-Acetylcysteine |
Group1, B1 |
Toxicity with paracetamol |
2g/ml |
|
Naloxone |
Group1, A1 |
Opioid poisoning with respiratory and CNS depression unresponsive to supportive therapy |
Injection 400mcg/ml; neonatal formulation 40mcg/2ml |
|
Neostigmine |
Group 1, B1 |
Curare type neuromuscular blockade |
Tablets 15mg, injection 2.5mg/ml |
|
Paraldehyde |
None |
Status epilepticus |
Injection 5ml |
Ideally administered rectally, IM in exceptional circumstances – injection is painful and abscess formation may occur; intravenous infusion NOT recommended |
Penicillamine |
Group 1, A1 |
Toxicity with copper |
Tablets 125mg, 250mg |
Penicillamine use should be restricted to cases where other chelating agents are unavailable. |
Phentolamine |
Group 1, A1 |
Toxicity with alpha-adrenergic agents |
10mg/ml |
|
Agent / drug |
IPCS Classification |
Indications |
Presentation |
Comments |
Phenytoin |
None |
Status epilepticus |
|
Patients should have blood pressure and ECG monitored continuously during therapy |
Physostigmine |
Group 1, A1 |
Central anticholinergic syndrome from atropine and other agents |
2mg/ml |
|
Polyethylene
glycol |
Group 2, B2 |
Solution for whole bowel irrigation |
|
|
Propanolol |
Group 1, A1 |
Toxicity with beta-adrenergic agonists, theophylline |
Tablets 10mg, 40mg, 80mg, 160mg; Injection 1mg/ml |
|
Protamine sulphate |
Group 1, A1 |
Toxicity with heparin |
Injection 10mg/ml |
|
Sodium calcium edetate (EDTA) |
Group 1, C2 |
Toxicity with lead |
Injection 1g/5ml |
|
Sodium nitrite |
Group1, A1 |
Toxicity with cyanide |
Injection sodium nitrite 3% (30mg/ml) |
|
Sodium thiosulphate |
Group 1, A1 |
Toxicity with cyanide |
Injection sodium thiosulphate 50% (500mg/ml) |
|
Agent / drug |
IPCS Classification |
Indications |
Presentation |
Comments |
Sorbitol
70% |
Group 2, B3 |
Toxicity with agents that warrant therapy with repeated doses of activated charcoal |
|
hould be administered ONCE ONLY with the initial dose of activated charcoal |
Trisodium edetate eye lotion |
None |
Alkali burns (especially lime) to the eye |
200mg/ml in 5ml. Requires dilution of 1ml to 50ml with sterile water |
|
Vitamin K(phytomenadione) |
Group 1, C1 |
Toxicity with coumarin derivatives, including warfarin |
Injection 1mg/0.5ml, 10mg/ml; tablets 10mg |
* group 1 = specific antidotes;
group 2 = agents to prevent absorption and enhance elimination;
group 3 = other useful agents
**Availability; A = available<30 minutes; B<2 hours; C<6
hours
Evidence; 1 = well documented; 2 = widely used, lack of evidence;
3 = questionable usefulness
Antidotes held in regional holding centres*
Agent / drug |
IPCS Classification |
Indications |
Presentation |
Comments |
Agent / drug |
IPCS Classification |
Indications |
Presentation |
Comments |
Digoxin specific Ab fragments |
Group 1, A1 |
Toxicity with digoxin |
Injection 38mg |
|
DMPS |
Group 1, B2 |
Toxicity with mercury |
Data regarding efficacy in toxicity with arsenic and lead is less convincing. Seek advice form NPIS |
|
DMSA |
Group 1, B2 (mercury), group 1, C3 (arsenic, cobalt, copper, lead, silver) |
Toxicity with mercury, arsenic, lead |
|
|
Agent / drug |
IPCS Classification |
Indications |
Presentation |
Comments |
Fomeptizole |
Group 1, A1 |
Toxicity with ethylene glycol, may be considered in cases of toxicity with ethanol |
Injection 1.5g/1.5ml |
Fomepizole is a second line agent after ethanol and haemodialysis for toxicity with ethylene glycol |
Hydrocobalamin |
Group 1, A1 |
Toxicity with cyanide |
Not first line therapy in cases of toxicity with cyanide. May be considered in the empirical management of toxicity with cyanide due to smoke inhalation. |
|
Prussian blue |
Group 1, B2 |
Toxicity with thallium |
Also stocked in CUH pharmacy |
|
Pyridoxine |
Group 1, B2 |
Toxicity with isoniazid |
|
|
Viper antivenom |
None |
Toxicity from the venom of the Vipera berus, the North European viper |
|
* group 1 = specific antidotes;
group 2 = agents to prevent absorption and enhance elimination;
group 3 = other useful agents
**Availability; A = available<30 minutes; B<2 hours; C<6
hours
Evidence; 1 = well documented; 2 = widely used, lack of evidence;
3 = questionable usefulness
