Specific Antidote

Analgesic Poisoning

Poison: Salicylate Overdose (Salicylism)

Antidote:

a. Alkalinize Urine with Sodium Bicarbonate
b. Consider Dialysis

Poison: Acetaminophen Overdose

Antidote: N-Acetylcysteine (NAC, Mucomyst, PO or Neb, Acetadote IV) based on nomogram

Poison: Opioid Overdose (Narcotic Overdose)

Antidote: Naloxone

Cardiovascular Agent Poisoning

Poison: Beta Blocker Overdose & Calcium Channel Blocker Overdose

Antidote:

a. Gastric Decontamination
b. Epinepherine
c. Glucagon
d. Calcium Replacement
e. Sodium Bi-Carbonate
f. Insulin Euglycemia protocol
g. Methylene blue

Poison: Digoxin

Antidote: Digoxin Immune Fab fragments (Digibind)

Psychiatric Agents Poisoning

Poison: Benzodiazepine Overdose

Antidote: Flumazenil (risk of Seizure if chronic daily Benzodiazepine use)

Poison: Serotonin Syndrome

Antidote: Cyproheptadine

Poison: Tricyclic Antidepressants Overdose

Antidote:

a. Sodium Bicarbonate to alkalinize the urine
b. Benzodiazepines for Seizure (avoid other anticonvulsants)

Heavy Metal and Metal Poisoning

Poison: Arsenic

Antidote: British Anti-Lewisite (BAL) Chelation or Dimercaprol

Poison: Iron

Antidote: Deferoxamine (Desferal)

Poison: Lead

Antidote:

a. Dimercaptosuccinic acid (DMSA, Succimer or Chemet)
b. Ethylenediaminetetraacetic acid (EDTA)

Poison: Mercury

Antidote: Dimercaptosuccinic acid (DMSA, Succimer or Chemet)

Agents interfering with Oxygenation

Poison: Carbon Monoxide

Antidote:

a. Oxygen
b. Hyperbaric chamber

Poison: Cyanide

Antidote:

a. Nitrites (Cyanokit, Sodium nitrite, Sodium thiosulfate)
b. Hydroxycobalamin (B12 analogue)
c. Oxygen

Poison: Methemoglobinemia

Antidote: Methylene blue

Parasympathetic Poisoning

Poison: Anticholinergics

Antidote: Physostigmine

Poison: Organophosphates or Cholinergic Poisoning

Antidote:

a. Atropine
b. Pralidoxime (2-PAMCl)

Miscellaneous Poisoning

Poison: Fluoride

Antidote: Calcium

Poison: Hydrazines

Antidote: Pyridoxine

Poison: Isoniazid (INH)

Antidote: Pyridoxine

Poison: Methanol or Ethylene Glycol

Antidote:

a. Fomepizole (Antizol)
b. Ethanol 10%

Poison: Oxalates

Antidote: Calcium

Poison: Hydrofluoric Acid

Antidote:

a. Risk of severe Hypocalcaemia and Hypomagnesaemia in even minimal exposures

b. Calcium Gluconate 2.5% gel applied to area

c. Calcium Gluconate 5% solution may also be injected into the region of contact

Poison: Sulfonylurea

Antidote:

a. See Sulfonylurea Overdose
b. Octreotide (Sandostatin)
c. Dextrose
d. Glucagon (temporizing measure only)

Poison: Valproic Acid

Antidote: Carnitine

Poison: Warfarin

Antidote:

a. Vitamin K
b. Fresh Frozen Plasma
c. Prothrombin Complex Concentrate 4 (PCC4)


Drugs and Their Antidote: Click Here