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 |
|
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