Antidotes


Antidotes at MUH, at CUH

National poisons information Antidotes Booklet.



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 Indications Presentation Comments
Activated Charcoal Reduction absorption toxic substances by GI tract that are adsorbed by charcoal 50g pack
Atropine Organophosphates, Carbamate insecticides Injection 600mcg/ml Use in cardiac arrest with ALS guidelines
Calcium gluconate
  1. Prevent transdermal adsorption of hydrofluoric acid (HF)
  2. Ca++ channel blocker XS
  3. Oxalates
A. Calcium gluconate gel 2.5%
B.& C. Calcium gluconate 10% 10ml vial
Cholestyramine ↓t½ and ↑clearance of oral anticoagulants (e.g warfarin) & long acting anticoagulants used as pesticides 4g sachet  
Cyproheptadine Serotonin syndrome 4mg tabs  
Dantrolene Drug-induced hyperthermia incl. neuroleptic malignant syndrome Tablets 25mg; injection 20mg Top of page
Desferrioxamin Toxicity with iron Injection 500mg
Diazepam Mx convulsions, anxiety, agitation and hypertonia 2° to toxins, toxicity with organophosphates Tablets 2mg, 5mg, 10mg; injection (Diazemuls) 10mg/2ml; rectal solution 2.5mg, 5mg, 10mg tubes
Dicobalt edetate Cyanide toxicity 300mg/20ml Confirm toxicity by measuring the serum cyanide concentration
Digoxin antibodies Digoxin toxicity   More on digoxin toxicity page or Digifab page
Dimercaprol 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
Agent / drug Indications Presentation Comments
Ethanol Toxicity with methanol and ethylene glycol Dehydrated alcohol (100% ethanol) 5ml injection
Flumazanil 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 :
1) Toxicity with TCADs [seizures]
2) Toxicity with unknown agents
3) Toxicity with cardiotoxic agents [arrhythmias] (Cocaine, amphetamines, tricyclic antidepressants, calcium channel blocking drugs, β-blockers and chloral hydrate)
4) Toxicity with agents that lower the seizure threshold (cocaine, amphetamines, tricyclic antidepressants, phenothiazines, theophylline)
5) Past history of epilepsy
6) History of long term therapy with benzodiazepines
Agent / drug

Indications

Presentation

Comments

Folinic acid Toxicity with folinic acid antagonists*;
Toxicity with methanol
Injection 15mg Used for * e.g. XS Methotrexate or Trimethoprim
Glucagon Toxicity with β-blockers 1mg Consider in toxicity with Ca++ channel blockers and other agents that cause myocardial depression. Seek advice from NPIS
Isoprenaline Toxicity with β- blockers Injection 0.2 mg/ml Kept in fridge in CUH resusc. room
Lorazepam First line therapy in status epilepticus Injection 4mg/ml; tablets 1mg Long half life compared with diazepam
Mensa ↓ urothelial toxicity in antineoplastic therapy 100mg/ml in 4ml amps  
    Top of page
Methionine Toxicity with paracetamol Tablets 500mg Useful in anaphylactoid reactions to n-acetylcystene but adsorbed by activated charcoal
Agent / drug

Indications

Presentation

Comments

Methylene blue Iatrogenic methaemaglobinaemia 100mg/10ml
N-Acetylcysteine Toxicity with paracetamol 2g/10ml Please see paracetamol toxicity page
Naloxone Opioid poisoning with respiratory and CNS depression unresponsive to supportive therapy Injection 400mcg/ml; neonatal formulation 40mcg/2ml
Neostigmine Curare type neuromuscular blockade Tablets 15mg, injection 2.5mg/ml
Octreotide Refractory hypoglycaemia induced by Sulphonylureas & quinnine    
Paraldehyde Status epilepticus Paraldehyde & olive oil enema Stocked in Ladybird ward CUH
Penicillamine Toxicity with copper, lead, copper and arsenic poisoning Tablets 125mg, 250mg Penicillamine use should be restricted to cases where other chelating agents are unavailable.
Phentolamine A) Toxicity with alpha-adrenergic agents B) Cocaine toxicity 10mg/ml Kept in CUH resusc. fridge
Agent / drug Indications Presentation Comments
Phenytoin Status epilepticus 250mg/5ml Patients should have blood pressure and ECG monitored continuously during therapy
Polyethylene glycol
(PEG)
Solution for whole bowel irrigation for drug mules (packers) Sachets
Pralidoxime Toxicic exposure to organophosphate insecticides 20% injection
Procyclidine Dystonic reactions 5mg/ml
Propanolol Toxicity with beta-adrenergic agonists, theophylline Tablets 10mg, 80mg, 160mg
Protamine sulphate Toxicity with heparin Injection 10mg/ml
Sodium calcium edetate (EDTA) Toxicity with lead 5% injection (0.5g in 10ml)
Sodium nitrite Toxicity with cyanide Injection sodium nitrite 3% (30mg/ml)
Sodium thiosulphate Toxicity with cyanide 20ml injection sodium thiosulphate 50% (500mg/ml)  
Starch powder Iodine poisoning 500g powder  
Vitamin K (phytomenadione) Toxicity with coumarin derivatives, including warfarin Injection 2mg/0.2ml, 10mg/ml; tablets 10mg Top of page

* group 1 = specific antidotes; group 2 = agents to prevent absorption and enhance elimination; group 3 = other useful agents
**Availability; A = available immediately; B<1 hour; C= Supraregionally
Evidence; 1 = well documented; 2 = widely used, lack of evidence; 3 = questionable usefulness


Antidotes held in regional holding centres*

Agent / drug Indications Presentation Comments
DMPS
(Dimercaptopropanesulfonic acid)
Toxicity with mercury Data regarding efficacy in toxicity with arsenic and lead is less convincing. Seek advice form NPIS
DMSA
(Dimercaptosuccinic acid)
Toxicity with mercury, arsenic, lead Stored in Beaumont NPIS
Agent / drug

Indications

Presentation

Comments

Fomepizole
(4-Mthylpyrazole)
Toxicity with ethylene glycol, may be considered in cases of toxicity with ethanol Injection 1.5g/1.5ml Fomepizole (HSE vs €)is a second line agent after ethanol and haemodialysis for toxicity with ethylene glycol. Fomepizole is stocked in the antidotes cupboard in the ED at MUH.
Hydrocobalamin 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 Toxicity with thallium

 

Kept in DDA press in CUH
Silibinin Amanita phalloides (death cap mushrooms) poisoning   Kept in Baeumont hospital
Pyridoxine Toxicity with isoniazid & ethylene glycol 100mg/2ml injection

* group 1 = specific antidotes; group 2 = agents to prevent absorption and enhance elimination; group 3 = other useful agents
**Availability; A = available immediately; B<1 hour; C= Supraregionally
Evidence; 1 = well documented; 2 = widely used, lack of evidence; 3 = questionable usefulness


Content by Dr Íomhar O' Sullivan 19/09/2002. Reviewed by Dr ÍOS 08/07/04. 13/05/2007, 22/03/2008, 28/05/2009. NPIS booklet published with permission 22/03/2008, 28/05/2009. Last review Dr C. Luke15/06/19.