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 the 2008 National Poisons Information Service (NPIS) Antidote booklet or https://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 |
|
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 IM. 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
|
| 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 |
|
10mg/ml | Kept in CUH resusc. fridge |
| Agent / drug | Indications | Presentation | Comments |
| Phenytoin | Status epilepticus | 250mg/5ml | Patients should have BP & 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 | |
| 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 Beaumont 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