California Poison Control System
10-14-2014
ANTIDOTE CHART
(Suggested Stocking Level is based on dose to treat a single 100 kg patient for 8 hours and
for 24 hours.* Large medical centers who may receive large numbers of patients in a single
incident must stock larger amounts of antidotes or have an effective and efficient drug
sharing/transfer procedure in place to rapidly obtain additional antidotal supplies.)
Generic/ Name
Brand
Atropine
Antivenom, Crotalidae
Polyvalent Immune-
FAB(ovine)/ Cro-Fab®
Antivenom, Black Widow
Spider/ Antivenom
(Latrodectus Mactans)®
BAL(Dimercaprol)/ BAL in
oil 10%
Bicarbonate , Sodium
Botulinum antitoxin/H-BAT-
heptavalent
Calcium Chloride injection
Calcium Gluconate Powder
Calcium Gluconate injection
Calcium Gluconate
gel/Calgonate 2.5% gel®
Indications
Organophosphate/
carbamate insecticide
poisoning and other
cholinesterase inhibitors (eg,
warfare agents); bradycardia
induced by a variety of
toxins
Rattlesnake envenomation
Black Widow Spider
envenomation
Heavy metal poisoning
Sodium channel blocker
(“membrane stabilizer”)
toxicity & urinary
alkalinization
Botulism
Calcium channel blocker
poisoning; hypocalcemia
induced by various agents
Hydrofluoric acid
Hydrofluoric acid skin
exposure or poisoning;
hypocalcemia induced by
various agents
Hydrofluoric acid dermal
burns
Suggested Access
Notes Stocking Priority
Level
May require large amounts in Immediate
severe cholinesterase inhibitor emergency
8 Hours: 100 mg or 13
poisoning. Also stocked in the department
vials (0.4 mg/mL, 20 mL
Strategic National Stockpile
each)
but will need supplies for first
24 hours: 200 mg or 26
48 hours. For mass casualties,
vials (0.4 mg/mL, 20 mL
local cache may provide
each)
supplies for first 48 hours
Use preservative free
coordinated by state
product
department of health and
emergency response system.
Within 1 hour
8 hours: 18 vials
24 hours: 36 vials
Special Access-
contact
Equine base risk of allergic 8 hours: 1 vial
manufacturer-
hypersensitivity. 24 hours: 1 vial
Merck (800)-672-
6372
8 hours: 600 mg or 2 amps Within 1 hour
(100 mg/mL, 3 mL each)
IM administration only.
24 hours: 1800 mg or 6
amps (100 mg/mL, 3 mL)
8 hours: 63 g (750 mEq) or Immediate
IV bolus dosing for reversal of
750 mL of 8.4% solution emergency
sodium channel blocker
24 hours: 84 g (1000 mEq) department
toxicity; monitor alkalemia.
or 1 L of 8.4% solution
Special Access;
CDC -1-770-488-
Only available through the
7100; California
CDC or state government.
call: 1-800-971-
9631
Can cause tissue necrosis if 8 hours: 10 gms or 10 vials Immediate
extravasation occurs – use (10%, 10 mL) emergency
large vein for infusion OR use 24 hours: 10gms or 10 department
calcium gluconate (see below). vials (10%, 10 mL)
8 hours: 1 x 100 g powder Within 1 hour
bottle
For manufacture of topical gel.
24 hours: 1 x 100 g powder
bottle
8 hours: 30 g or 30 vials Immediate
(10%, 10 mL) emergency
24 hours: 30 g or 30 vials department
(10%, 10 mL)
8 hours: 6 x 25 gm tubes Within 1 hour
For topical burns.
24 hours: 10 x 25 gm tubes

Carnitine (L-Carnitine)/
Carnitor®
Cyanide Antidote Kit
(Nithiodote by Hope
Pharmaceuticals)
 Sodium Nitrite
 Sodium Thiosulfate
Cyanokit®/
Hydroxocobalamin
Cyproheptadine/ Periactin®,
others
Dantrolene
Deferiprone/ Ferriprox®
Deferoxamine/ Desferal
Digoxin Immune FAB
(ovine)/ DigiFab®
DMSA (Succimer)/ Chemet
Hyperammonemia from
valproic acid toxicity
Cyanide;
Sodium nitroprusside toxicity
Cyanide
Cyanide;
Sodium nitroprusside toxicity
Cyanide poisoning
Mild to moderate serotonin
syndrome
Malignant hyperthermia
Iron overload
Iron poisoning
Digoxin poisoning; other
cardiac glycosides (eg,
oleander, foxglove)
Heavy metal poisoning
8 hours: 10g or 10 x 1 g Within 1 hour
vials
24 hours: 20 g or 20 x 1 g
vials
2 kits for small hospitals, 6 Immediate
kits for major medical emergency
Conventional cyanide antidote:
centers or stock separate department
contains 1-10mL (300mg) vial
supplies of sodium
of sodium nitrite, 1-50 mL
thiosulfate and sodium
(12.5G) vial of sodium
nitrite vials OR stock the
thiosulfate (amyl nitrite inhalant
Cyanokit®
ampules not included).
(hydroxocobalamin)
antidote kit (see below)
2 x 10 mL (3%) vials; 6 vials Immediate
for major medical centers emergency
Risk of methemoglobinemia
(Less expensive: Stock department
with use.
instead of the Cyanide
antidote kit)
If used alone for cyanide Immediate
2 x 50 mL (25%) vials; 6
toxicity, may have a slow onset emergency
vials for major medical
of action. Thiosulfate is department
centers
synergistic with sodium nitrite,
(Less expensive: Stock
and the two drugs should be
instead of the Cyanide
used together to treat cyanide
antidote kit)
poisoning whenever possible.
8 hours: 10 g or 2 kits Immediate
Newer, safer and easier to use 24 hours:10 g or 2 kits emergency
than the conventional cyanide (OR stock the cyanide department
antidote kit. antidote kit or the individual
kit components)
8-24 hours: 32 mg or 8 Within 1 hour
Anticholinergic side effects and tablets (4 mg each)
only PO administration.
8 hours: 1000 mgs or 50 x Immediate
20 mg vials emergency
24 hours: 1300 mgs or 56 department
vials
8 hours: 3.3 g or 7 x 500 Specialty/optional
mg tablets
PO Chelator. 24 hours: 9.9 g or 20 x 500
mg tablets
8 hours: 12 g or 6 x 2 g Within 1 hour
vials
IV use only.
24 hours: 36 g or 18 x 2 g
vials
Consult with poison center 8 hours: 15 vials of either Immediate
regarding dosing, especially product emergency
for cardiac glycosides than 24 hours: 20 vials of either department
digoxin. product
8 hours: 1 g or 10 x 100 Within 1 hour
mg capsules
24 hours: 3 g or 30 x 100
mg capsules

DTPA-Calcium
(Diethylenetriamine
pentaacetate)/ Pentetate
Calcium Trisodium
injection)
DTPA-Zinc
(Diethylenetriamine
pentaacetate)/ Pentetate
Zinc Trisodium injection)
EDTA-Calcium/ Versenate
Ethanol IV 10% with 5%
Dextrose
Ethanol (oral) / Vodka
Flumazenil/ Romazicon
Fomepizole (4-MP)/ Antizol
/generics/X-Gen
Pharmaceuticals
Glucagon
Glucarpidase/ Voraxaze®
Insulin
Dirty bomb agents:
radioactive plutonium,
americium and curium
Dirty bomb agents:
radioactive plutonium,
americium and curium
Heavy metal poisoning
Ethylene glycol or methanol
poisoning
Ethylene glycol or methanol
poisoning
Benzodiazepine poisoning
Preferred antidote for
ethylene glycol or methanol
poisoning
Beta blocker/calcium
channel blocker poisoning
Methotrexate toxic levels
Hyperinsulinemia -
euglycemia (HIE) therapy for
calcium antagonist and beta-
blocker poisoning
Special access-
Strategic National
Stockpile. The
Radiation
Only available through
Emergency
government sources. Stocked
Assistance
in the Strategic National
Center/Training
Stockpile. Local cache will 8 hours: 1 x 1 g amp
Site (REAC/TS)
provide supplies for first 48 24 hours: 1 x 1 g amp
can be contacted
hours coordinated by state
for information on
department of health and
use of antidote.
emergency response system.
business hours:
1-865-576-3131;
afterhours: 1-865-
576-1005.
Special access-
Strategic National
Stockpile. The
Radiation
Only available through
Emergency
government sources. Stocked
Assistance
in the Strategic National
Center/Training
Stockpile. Local cache will 8 hours: 1 x 1 g amp
Site (REAC/TS)
provide supplies for first 48 24 hours: 1 x 1 g amp
can be contacted
hours coordinated by state
for information on
department of health and
use of antidote.
emergency response system.
business hours:
1-865-576-3131;
afterhours: 1-865-
576-1005.
8 hours: 1 g or 1 1000 Within 1 hour
Note: Do not confuse with mg/5mL amp
“Sodium” EDTA. 24 hours: 3 g or 3 1000
mg/5mL amps
Note: IV 10% ethanol product 8 hours: 2 x 1 liter Within 1 hour
no longer manufactured. 24 hours: 4 x 1 liter
Fomepizole easier to dose and (Can be prepared using
monitor than ethanol. 95% ethanol product)
Fomepizole easier to dose and Within 1 hour
monitor than ethanol. Oral 8 hours: one pint
ethanol can be used in an 24 hours: 750mL
emergency situation.
Use small initial dose to avoid Immediate
abrupt awakening/ delirium. Do emergency
8 hours: 6 mg or 6 x
not use in patients on chronic department
1mg/10 mL vials
benzodiazepine therapy as
24 hours: 12 mg or 12 x 1
withdrawal seizures may
mg/10 mL vials
occur. Also use with caution in
mixed drug overdoses.
8 hours: 1.5 g or 1 x 1.5mL Immediate
Manufacturer will replace (1g/mL) vials emergency
expired stocks. 24 hours: 6.0 g or 4 x 1.5 department
mL (1g/mL) vials
8 hours: 90 mg or 90 x 1 Immediate
Anticipate nausea and mg kits emergency
vomiting. 24 hours: 250 mg or 250 x department
1 mg kits
Use in patient with toxic levels Specialty/optional
and impaired renal function.
May also metabolize 5 vials(1000U/vial)
leucovorin so stagger doses at
least 2 hours.
8 hours: 1000 U or one vial Immediate
(100 U/mL, 10mL each) emergency
Accompany with dextrose if
24 hours: 3000 U or three department
blood glucose < 200 mg/dL.
vials (100 U/mL, 10mL
each)

Intravenous Fat Emulsion/
Lipophilic cardiotoxic drugs
Intralipid
Folic acid
Leucovorin calcium
antagonists/methanol
Methylene Blue Methemoglobinemia
N-Acetylcysteine (NAC) Acetaminophen poisoning
Mucomyst or generic (oral preparation)
N-Acetylcysteine (NAC) Acetaminophen poisoning
Acetadote® (IV preparation)
Naloxone/ Narcan Opioid overdose
Octreotide acetate/ Oral sulfonylurea poisoning
Sandostatin and meglitinide poisoning
Anticholinergic poisoning,
Physostigmine/ Antilirium® especially antimuscarinic
delirium.
Cholinesterase Inhibitor
Pralidoxime(2-PAM)/
poisoning (organophosphate
Protopam
or “nerve gas”)
Protamine Heparin reversal
Immediately after Immediate
8-24 hours: 3300 mL of
administration several emergency
20% or 3 bags(100mL
laboratory tests of patient department
each) plus 6 bags (500 mL
serum/blood may be
each)
uninterpretable.
8-24 hours: 300 mg or 3 Within 1 hour
(100 mg) vials
8 hours: 400 mg or 4 x 10 Immediate
mL (10 mg/mL) amps emergency
24 hours: 600 mg or 6 x 10 department
mL (10 mg/mL) amps
8 hours: 28 g or 5 x 30mL Immediate
Use orally. Dilute at least by a (20%) vials emergency
3:1 ratio. 24 hours: 56 g or 10 x 30 department
mL (20%) vials
Note: 3 different dilutions are Immediate
used for 1, 4 and 16 hour emergency
infusions. Loading dose department
should be infused slowly over 8 hours: 24 g or 4 x 30 mL
45-60 minutes. Generic N- (20%) vials
acetylcysteine can be used if 24 hours: 30 g or 5 x 30
Acetadote® is not available mL (20%) vials
(consult with poison center and
administer via a micropore
filter).
8 hours: 20 mg or 50 x 0.4 Immediate
mg/2mL amps or 2 x 10 emergency
Use small initial dose to avoid
mg/10mL vials department
abrupt awakening/withdrawal.
24 hours: 40 mg or 4 x 10
mg/mL vials
8 hours: 200 mcg or 2 x Within 1 hour
1mL (0.1mg/mL) amps
Avoid long-acting depot
24 hours: 1000 mcg or 1 x
products.
5mL (0.2mg/mL) Multidose
Vial
Administer at low dose (0.5 Immediate
mg) and slowly, over 2-5 emergency
minutes to avoid severe 8 hours: 4 mg or 2 x 2mL department
adverse reactions including (1mg/mL) amps
bradycardia, asystole and 24 hours: 20 mg or 10 x 2
seizures. (Contraindicated in mL (1 mg/mL) amps
TCA or similar poisoning with
widened QRS intervals.)
Also stocked in the Strategic Within 1 hour
National Stockpile but will
need supplies for first 48
8 hours: 7 g or 7 x 1 gm
hours. For mass casualties,
(20 mL) vials
local cache may provide
24 hours: 18 g or 18 x 1
supplies for first 48 hours
gm (20 mL) vials
coordinated by state
department of health and
emergency response system.
8-24 hours: 500 mg or 2 Within 1 hour
May also partially neutralize vials (10mg/mL, 25 mL
low-molecular weight heparins. each)

Dirty bomb agents:
Prussian Blue/ radioactive cesium and
Radiogardase® thallium and non-radioactive
thallium
Pyridoxine (Vitamin B6) Isoniazid (INH) poisoning
Vitamin K1(Phytonadione)/ Warfarin, warfarin-based
anticoagulants and super-
Mephyton or warfarin based rodenticide
AquaMephyton poisoning
Expert advice regarding use of antidotes and treatment of poisoning and overdose is
available 24 hours a day, 7 days a week from the California Poison Control System.
Special access-
Strategic National
Stockpile. The
Radiation
Only available through
Emergency
government sources. Stocked
Assistance
in the Strategic National
Minimum order is 25 bottles Center/Training
Stockpile. Local cache will
(30 capsules each) Site (REAC/TS)
provide supplies for first 48
can be contacted
hours coordinated by state
for information on
department of health and
use of antidote.
emergency response system.
business hours:
1-865-576-3131;
afterhours: 1-865-
576-1005.
Large amounts needed for Immediate
poisoning: 5 grams is the emergency
minimum antidotal dose used department
in an ingestion of an unknown 8 hours: 9 g or 3 vials (100
amount. Note: the 30 mL vials mg/mL, 30 mL each) or the
may only be available from equivalent (Use
compounding pharmacies. The preservative free product.)
100 mg in 1 mL vials may 24 hours: 24 g or 8 vials
contain the preservative (100 mg/mL, 30 mL each)
chlorobutanol. A 5 gram dose or the equivalent
requires 50 of these vials and
may deliver a toxic dose of the
preservative.
8 hours: 50 mg or 10 x 5 Within 1 hour
mg tabs or 5 x 10 mg/mL
If patient is actively bleeding
amps
use fresh frozen plasma or
24 hours: 200 mg or 40 x 5
Factor VII concentrate.
mg tabs or 20 x 10 mg/mL
amps

Health Professionals, call 1-800-411-8080

Members of the public, call 1-800-222-1222
*Adapted from Dart RC et al. Annals of Emergency Medicine. 2009; 54(3):386-394.
Note: List is not all-inclusive but reflects agents used more exclusively as antidotes
or antidotal agents used infrequently.
Updated: 10-14-2014