Pharmacological Antidotes Table Copyright Pharmacology Weekly, Inc.

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Drug Toxicity
Acetaminophen (APAP)
Amphetamines & derivatives
Anesthesia
Anticholinergics
Antifreeze (ethylene glycol)
Antipsychotic-Induced
Neuroleptic Malignant Syndrome
Aspirin (salicylic acid; ASA)
Benzodiazepine
Beta Blockers
Black Widow Spider Bite
Calcium Channel Blockers
Carbon monoxide (CO)
Cyanide (CN)

Antidote
N-acetylcysteine (Acetadote IV; Mucomyst)
Antipsychotics (e.g., haloperidol for dopamine antagonism);
GABA activating drugs (benzodiazepines, phenobarbital)
Dantrium (Dantrolene)
Physostigmine
Fomepizole (Antizol) or Ethanol 10% given IV
Dantrium (Dantrolene) or Bromocriptine

Note(s)
IV faster and shorter duration, but small risk of allergic reaction.
Amphetamines increase release of dopamine & norepinephrine. Treatment: Block dopamine
receptors; suppress the CNS from over stimulation.
Interferes with Ca++ release via Ryr receptor on sarcoplasmic reticulum; muscle relaxation.
Must be on cardiac monitor. Get ECG first.
Fomepizole is a competitive inhibitor of alcohol dehydrogenase & toxic metabolites.
Interferes with Ca++ release via Ryr receptor on sarcoplasmic reticulum; muscle relaxation.

Alkalization of urine +/- Dialysis

Flumazenil (Romazicon)
Glucagon; High dose insulin/glucose; +/- Cardiac pacing
Benzodiazepines (if seizures)
Black Widow Spider Antivenin (Latrodectus Mactans)
Calcium chloride or gluconate; +/- glucagon; +/- dopamine (if
hypotensive)
Oxygen via non-rebreather mask; hyperbaric oxygen
Amyl Nitrate, sodium nitrite, then Sodium Thiosulfate
Hydroxocobalamin (Cyanokit; a hydroxylated form of B12)

Cause ionization of ASA thereby causing ion trapping for renal elimination.
Caution rapid and/or overcorrection can cause seizure.
Glucagon can increase myocardial contractility, pulse, and AV conduction.

Digoxin
Ethylene glycol (Antifreeze)
Heparin (UFH)
Hydrofluoric acid
Iron (Fe)
Isoniazid (INH)
Isopropyl alcohol
Lead (Pb)

Digoxin Immune Fab (Digibind)

Fomepizole (Antizol)
Protamine sulfate
Calcium gel
Deferoxamine (Desferal)
Pyridoxine (vitamin B6)
Hemodialysis
Succimer (Chemet); DMSA (Meso-2,3-dimercaptosuccinic acid)

Low Molecular Weight Heparins

Mercury (Hg)
Methanol (Windshield Wiper
Fluid, Sterno, Paint Solvent)
Methotrexate
Neuromuscular Blockers (Nondepolarizing Agents)
Nitrates
Opioids
Organophosphates/Pesticides

Protamine sulfate
Succimer (Chemet); DMSA (Meso-2,3-dimercaptosuccinic acid)
Fomepizole (Antizol) or Ethanol 10% given IV

Snake Bite (Rattle Snake)

Sulfonylureas (SU)
Thrombolytics
Tricyclic Antidepressants (TCA)
Valproic acid
Warfarin (Coumadin, Jantoven)

Leucovorin
Edrophonium (Enlon), neostigmine (Prostigmin)
Methylene blue
Naloxone (Narcan)
Atropine +/- pralidoxime (2-PAM; Protopam)
Body decontamination
Crotalidae polyvalent immune Fab Ovine (CroFab)
Octreotide (Sandostatin)
Aminocaproic acid; tranexamic acid; aprotinin
Sodium bicarbonate
Naloxone +/- Dialysis +/- L-carnitine
Vitamin K (Phytonadione; Mephyton)

Can see target lesion. Venom neutralizing antibodies (equine). Can be given up to 90 hrs after bite.
Verify not digoxin toxicity as hypercalcemia can worsen it.
CO causes lactic acidosis. If pregnant give longer treatment due to presence of fetal Hgb.
CN causes lactic acidosis. Amyl nitrate induces a methemoglobin in RBC to combine CN, Na
thiosulfate conversion of CN to thiocyanate for renal elimination. Each hydroxocobalamin
molecule binds to one CN molecule to form cyanocobalamin for renal clearance.
Fab portions only of antibodies generated from sheep that bind to digoxin.
Fomepizole is a competitive inhibitor of alcohol dehydrogenase & oxalic acid formation.
Neutralizes heparin. Caution as it can act as an anticoagulant as well.
Mixture of 1 amp Ca gluconate with 2-3 packs of Surgilube.
Chelates with iron from ferritin & hemosiderin (not transferrin or Hgb) to make water soluble.
Replenishes reductions in vitamin B6.
Forms acetone & risk for coma. No anion gap seen, but does osmolar gap.
Can see basophilic stippling on histology. Chelates with lead to form water soluble chelates for
urinary excretion. SE: possible bone marrow suppression. Not indicated for prophylaxis.
60-75% effective; requires staggered dosing.
May chelate with Hg. Not approved for Hg toxicity. Can also try penicillamine.
Fomepizole is a competitive inhibitor of alcohol dehydrogenase & formic acid formation (optic
nerve damage/blindness). Sterno is a chafing fuel or portable fires in the foodservice industry.
FH4 derivative that bypasses dihydrofolate reductase being inhibited by methotrexate.
Cholinesterase inhibitors increase acetylcholine levels at NMJ. Non-depolarizing agents
(atracuronium, mivacurium, pancuronium, rocuronium, tubocurarine)
Goal methemoglobin <20%; less effective in G6PD.
Except meperidine induced seizures.
Atropine antagonizes muscarinic receptors (anticholinergic effect). 2-PAM attempts to reactivate
acetylcholinesterase that was inactivated by phosphorylation.
IgG antibody that neutralizes venom toxins. Best used within 6 hours of bite.
Block/suppress insulin release due to SU and/or glucose.
Inhibit plasminogen activation; inhibits plasmin (aprotinin).
Monitor ECG and ABG; if seizures give benzodiazepines.
VPA metabolites can induce NH3+ & GABA (naloxone may displace from receptor).
IV associated with > side effects; avoid unnecessary over correction; monitor H/H, INR.

Version: 1.2013. Developed & Reviewed by: Anthony J. Busti, MD, PharmD, FNLA, FAHA; Gregory McKeever, MD; Medical Director. Please check www.pharmacologyweekly.com for current version and disclaimer.