ANTIDOTE CHART

ANTIDOTE TOXIC EXPOSURE INDICATION DOSE LAB MONITORING ADVERSE REACTIONS COMMENTS
N-Acetylcysteine, Acetaminophen - Acute ingestion of PO: AST, ALT, PO: Nausea, - Do not draw APAP levels
NAC (Mucomyst) >7.5g (adults) or Loading dose: 140mg/kg bilirubin, PT, vomiting, other GI before 4 hours post-acute
>150mg/kg (children) Maintenance dose: 70mg/kg creatinine, BUN, symptoms ingestion as they are not
- Serum APAP level q4h x 17doses blood glucose, IV: Rash, pruritus, predictive of toxicity
>150mg/L at 4 hours Each dose should be diluted and electrolytes tachycardia, - If the patient vomits
post-ingestion to a final concentration of 5% should be hypertension, within 1 hour of an oral
- Chronic ingestion of with PO fluid of choice checked daily hypotension, and NAC dose, repeat the
potentially toxic during NAC bronchospasm (rare dose. Use antiemetics as
amounts IV: therapy but more associated needed.
Loading dose: 140mg/kg with IV)
Maintenance dose: 70mg/kg
q4h x 12 doses
Dilute dose in an appropriate
crystalloid solution to a final
concentration of ~3-4% and
infuse over 1 hour as part of
maintenance fluids

Antivenin, Crotaline snake Mild, moderate or - Perform sensitivity testing CBC with Hypersensitivity - Do not inject antivenin
Crotalidae envenomation (rattle severe envenomation prior to dose. See package platelets, PT, PTT, reaction, around the bite site.
polyvalent snake, copperhead, Mild – Local swelling, insert fibrinogen, fibrin anaphylaxis, serum Never inject antivenin in
(equine origin) cottonmouth) no systemic or lab - Give dose as soon as degradation sickness a toe or finger
abnormalities possible products (FDP), - Do not apply ice or
Moderate – Swelling Mild – 0-10 vials UA, H/H, BUN, torniquets. Do not
increased beyond Moderate – 10 – 20 vials serum creatinine, attempt to incise fang
bite site, ≥1 systemic Severe - ≥20 vials electrolytes. marks
manifestation, - See package insert for Check q4h for at - If the patient is sensitive
abnormal lab administration least the first 12 to horse serum or other
changes recommendations hours antivenin components,
Severe – Marked administration of
local response, diphenhydramine,
severe systemic corticosteroids and
effects, significant lab epinephrine may be
abnormalities required
- Update tetanus if
needed.

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 ANTIDOTE CHART
Antivenin, North American crotalid Mild, moderate or Initial dose: 4-6 vials IV over 1 CBC with Mild hypersensitivity - Most effective if given
Crotalidae snake envenomation severe envenomation hr (25-50mL/hr for the first 10 platelets, PT, PTT, (urticarial, rash) within 8 hours of the
polyvalent (rattlesnake, Mild – Local swelling, mins., increase to 250mL/hr if fibrinogen, fibrin reaction, especially bite
immune fab copperhead, no systemic or lab no adverse response) Repeat degradation to those allergic to - Do not apply ice or
(ovine origin) cottonmouth) abnormalities dose at 1 hr intervals until products (FDP), papaya or papain torniquets. Do not
(CroFab) Moderate – Swelling control of symptoms is UA, H/H, BUN, attempt to incise fang
increased beyond achieved serum creatinine, marks.
bite site, ≥1 systemic Maintenance dose: Once electrolytes. - This product has much
manifestation, symptoms are controlled, give Check q4h for at less risk of
abnormal lab 2 vials q6h for 3 more doses. least the first 12 hypersensitivity reaction
changes Additional doses of 2 vials hours than the horse-serum
Severe – Marked each may be administered as based product.
local response, needed depending on patient - Update tetanus if
severe systemic response needed.
effects, significant lab *Reconstitute vial with 10mL
abnormalities sterile water for injection.
Further dilute in 250mL NSS
and infuse over 1 hour.
Antivenin, Black widow spider Severe or life- - Perform sensitivity testing Electrolytes, Hypersensitivity - Most beneficial when
Latrodectus envenomation. Also threatening prior to dose. See package calcium, glucose, reaction, given within 4 hours of
mactans (equine effective for other envenomation insert. CPK anaphylaxis, serum envenomation
origin) species of Latrodectus - IV: Dissolve 1 vial (2.5mL) in sickness
10-50 mL of D5W or NSS
and infuse over 15-30 mins.
IV is preferred in cases of
severe shock and in children
<12 years old
Antivenin, Eastern and Texas coral Positive identification - Perform sensitivity testing Routine labs Hypersensitivity - Most beneficial when
Micrurus fulvius snake envenomation of a coral snake, or prior to dose. See package reaction, given within 4 hours of
(equine origin) signs and symptoms insert anaphylaxis, serum envenomation
of coral snake - Initial dose: 3-5 vials diluted sickness - Do not apply ice or
envenomation in 250-500 mL of NaCl given torniquets. Do not
by slow IV infusion attempt to incise fang
- Additional antivenin may be marks.
necessary. - This product has much
- See package insert for less risk of
administration hypersensitivity reaction
recommendations than the horse-serum
based product.

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 ANTIDOTE CHART
Atropine Organophosphate and For treatment of Adults: Initial dose of 1-2mg
carbamate pesticides, cholinergic (SLUDGE) IV
muscarine-containing symptoms due to Children: Initial dose of 0.05
mushrooms, drugs and chemicals mg/kg IV
acetylcholinesterase that inhibit - Individualize dose on the
inhibitors (i.e. tacrine, acetylcholinesterase basis of response to initial
donepezil) activity dose. Repeat as necessary
q15-30 mins until signs of
atropinization (i.e. flushing,
drying of secretions,
mydriasis if pinpoint pupils
are present). Large doses
may be required.
Calcium EDTA Lead For acute and chronic Adults: 1g in 250-500mL of
lead poisoning and NSS or dextrose 5% infused
lead encephalopathy slowly over >1hr (or give IM
with procaine) for 5 days,
interrupt therapy for 2 days;
repeat for 5 days if indicated
Children: 35-50 mg/kg/day IV
slowly; dose is given q8-
12hrs; give for 3-5 days
depending on lead levels;
minimum of 2 days need to
elapse before considering a
repeat dose
Charcoal, GI decontamination - For binding of a Adults: 25-100 g PO or NG
activated potentially toxic Children: 1g/kg PO or NG
substance in the GI Multiple Dose: Use aqueous
tract charcoal only. Repeat the
- Ineffective for dose q4h. Can be given in
alcohols, certain overdoses to enhance
hydrocarbons, elimination (i.e. theophylline,
metals and phenobarbital, salicylates,
Retyped by M. Magadia and H. C. Cutero
- Update tetanus if
needed.
Organophosphate Dryness of mucous - For severe cases, may
poisoning: Serum membranes, need continuous
(or RBC) tachycardia, atropine infusion. Taper
cholinesterase mydriasis, before discontinuation.
level flushes/dry/hot skin,
fever (esp. in
children),
constipation,
hallucinations and
delirium (in excess
doses)
Perform a UA Renal toxicity, pain at - Ineffective for lead
daily, renal IM injection site, levels < 30-40 mcg/dL
function tests, fever, chills, - Not recommended as
LFTs, urine output hypotension, nausea, sole agent for levels ≥
vomiting, anorexia, 70 mcg/dL or in those
tremors, headache, with s/sx of
tingling, numbness, encephalopathy; use
mild increase in LFTs, with BAL
histamine-like - Perform abdominal
reaction, zinc radiograph to confirm
deficiency, absence of lead in GI
hypercalcemia, tract.
anemia, transient
bone marrow
depression
None needed. Vomiting, diarrhea or - For pediatric
constipation administration, avoid
adding a cathartic. May
be mixed with soda
- Most effective if given
within 1 hr of ingestion
- Do not use in patients
with CNS depression or
 ANTIDOTE CHART
inorganic minerals carbamazepine, sustained- at risk for seizures
(i.e. iron, lead, release products) without airway
lithium, arsenic, protection
cyanide)
Cyanide Antidote Cyanide Treatment of cyanide See package insert Whole blood Methemogolbinemia, - If signs of poisoning
Kit (sodium poisoning in cyanide levels, hypotension, reappear, give sodium
nitrate, sodium significantly ABGs, O2 sats, headache, facial nitrate and sodium
thiosulfate, amyl symptomatic patients electrolytes, flushing, dizziness, thiosulfate at ½ the
nitrite) methemoglobin nausea, vomiting, original dose
(metabolic tachycardia,
indicator) levels if sweating
indicated
Deferoxamine Iron - Treatment of acute - 15mg/kg/hr IV infusion (up Serum iron, Hypotension (more - The normal serum iron
(Desferal) iron toxicity (those to 35-45 mg/kg/hr have glucose, WBCs, common with rapid level – 50-150 mcg/dL
with s/sx of iron been used for massive abdominal infusion), rash, - The ferrioxamine
toxicity or serum poisoning) radiographs (KUB generalized chelate may discolor the
iron level >350- - Max daily dose is 6 grams – see comments), erythema, allergic- urine to a pink to red-
500mcg/dL) (up to 16g/day have been CBC, electrolytes, type reaction, orange color (vin rose)
- Chronic iron tolerated) BUN, serum injection site - Continue treatment
overload - May be given IM but IV is creatinine, LFTs reaction until s/sx resolve, the
- Iron tablets = not preferred serum iron level is
rapidly absorbed <150mcg/dL and a
and stay in GIT repeat KUB is negative
longer  clamp up for the presence of iron
and make larger in the GIT
material called - KUB is valuable to
PHARMACOBEZOA identify those at risk for
RS continued iron
absorption
Digoxin immune Digoxin, digitoxin - Treatment of - Perform sensitivity testing Serum digoxin Allergic reactions - Total serum digoxin may
fab (ovine origin) potentially life- in high risk patients prior to levels (obtain (rare), low cardiac rise precipitously
(Digibind) threatening administration (i.e. those before output, CHF, following Fab
intoxication (i.e. with known allergies or administration), hypokalemia, rapid administration.
severe ventricular previously treated with frequently check ventricular response However, this will be
arrhythmias, Digibind) potassium levels, in patients with atrial almost entirely bound to
progressive - Contact local poison control serum fibrillation the Fab fragments and
bradyarrhythmias center or see package insert magnesium, other therefore not able to
nd rd
or 2 or 3 degree for dosing instructions. electrolytes, BUN, react with the receptors
heart block not serum creatinine in the body.

Retyped by M. Magadia and H. C. Cutero

 ANTIDOTE CHART
responsive to
atropine)
- Patient has
ingested >10mg of
digoxin (adults) or
>4mg (children
- Serum
concentrations >10
ng/mL
- Serum potassium
>5mEq/L in this
setting/hyperkalem
ia
Dimercaprol (BAL Arsenic, gold, mercury, - Treatment of - Give as deep IM injection Renal function ADRs are dose- - Avoid use in patients
– British Anti- and lead arsenic, gold and - Mild arsenic or gold tests, urine pH related and include allergic to peanut oil
Lewisite -in oil) acute mercury poisoning: 2.5 mg/kg 4 (See comments) the following: pain at - Urinary alkalinization is
poisoning (if times daily for 2 days. 2 injection site, recommended because
started within 1-2 times daily on the third day, increase in blood BAL-metal complex
hours) then once daily thereafter pressure, breaks down easily in an
- Treatment of acute for 10 days tachycardia, nausea, acid medium. Alkaline
lead poisoning of - Severe arsenic or gold vomiting, fever, urine protects the
levels ≥70mcg/dL, poisoning: 3mg/kg q4h for headache, kidneys during therapy.
when used with 2 days, 4 times daily on the restlessness, increase - Do not use for alkyl
calcium EDTA third day, then twice daily in salivation, organic mercury
- Not effective for thereafter for 10 days nephrotoxicity, and, poisoning as it may
chronic mercury - Mercury poisoning: 5mg/kg rarely, convulsions actually worsen
poisoning initially, followed by 2.5 nephrotoxicity
mg/kg 1-2 times/day for 10 - Use with caution in
days patients with G6PD
- Acute lead deficiency as hemolysis
encephalopathy: 4mg/kg may occur
alone in the first dose and (contraindication)
thereafter after 4 hr
intervals in combination
with calcium EDTA
administered at a separate
site
- Less severe lead poisoning:
Dose can be reduced to

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 ANTIDOTE CHART
3mg/kg after the initial
dose. Maintain treatment
for 2-7 days depending on
clinical response
Ethanol Ethylene glycol - Any symptomatic - Therapeutic blood alcohol - Stat blood Inebriation, CNS - Continue treatment
(antifreeze), methanol patient with level = 100 mg/dL alcohol level, depression, until ethylene glycol or
suspected - Loading dose: 8-10mL/kg of then repeat q hypoglycemia methanol level is
ingestion of 10% ethanol (v/v) IV over 1-2 hrs until (especially in <20mg/dL and the
ethylene glycol or 30 min steady state is children), respiratory patient’s symptoms
methanol - Maintenance: IV infusion of reached then q depression have resolved including
- Ethylene glycol or 0.8 mL/kg/hr for non- 2-4 hrs a normal serum pH
methanol levels drinkers (2 mL/kg/hr for - Also serum - Fomepizole inhibits the
>20mg/dL chronic drinkers) of 10% ethylene glycol elimination of ethanol.
- History or ethanol (v/v). Begin and/or Therefore, concomitant
suspected maintenance dosing methanol administration of
ingestion of toxic concurrent with loading levels, serum ethanol with fomepizole
amounts and in dose. glucose and is not recommended as
whom blood levels - Doses should be electrolyte, toxic ethanol levels may
are not readily administered as an IV ABGs, UA, result
available infusion of 10% ethanol serum
(v/v) in D5W osmolality (by
- Adjust dose if patient freezing point
presents with an existing depression),
blood alcohol level or in calcium, renal
those undergoing function and
concomitant hemodialysis anion gap
*stock doses of ethanol =
10% or 5%
Flumazenil Benzodiazepines (BZD) Complete or partial Adults: For BZD overdose, Routine labs Dizziness, agitation, - Take caution when using
(Romazicon) reversal of the give 0.2 mg (2mL) IV over 30 dry mouth, tremors, flumazenil in a mixed
effects of seconds. If desired level of palpitations, drug overdose; toxic
benzodiazepines consciousness is not obtained insomnia, dyspnea, effects (i.e. seizures,
after waiting 30 seconds, then hyperventilation, dysrhythmias) of other
give 0.3 mg (3mL) over emotional drugs taken (especially
another 30 seconds. Further __________, tricyclic
doses of 0.5 mg (5 mL) can be Confusion, antidepressants) may
given over 30 seconds to 1 convulsions, emerge
min intervals up to a cutaneous - Reversal of BZD may
cumulative dose of 3 mg. vasodilation, nausea, precipitate withdrawal

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 ANTIDOTE CHART
- For resedation, give
repeated doses q20 mins if
needed. For repeat
treatment give ≤1mg (given
as 0.5 mg/min) at any one
time and no more than 3
mg in any one hour
Children: 0.01 mg/kg over 1
min. Repeat doses of 0.01
mg/kg may be given at 1
minute intervals up to 1 mg
total dose.
Fomepizole Ethylene glycol, - Any symptomatic Loading dose: 15mg/kg
(Antizol) methanol patient with Maintenance dose: 10mg/kg
suspected q12 h for 4 doses, then
ingestion of 15mg/kg q 12 h until level is
ethylene glycol or <20mg/dL and the patient is
methanol asymptomatic with normal pH
- Ethylene glycol or Administration: Dilute doses
methanol levels in ≥100 mL NSS or 5%
>20mg/dL dextrose and infuse over 30
- History or mins.
suspected - For concomitant
ingestion of toxic treatment with
amounts and in hemodialysis, see
whom blood levels package insert for
are not readily dosing instructions
available
Glucagon Beta-blockers, possibly To aid in improving Adults: 5-10mg IV over 1
(Recombinant calcium channel arterial pressure and minute, followed by a 1-5
DNA) blockers contractility due to mg/hr IV infusion
an overdose of a
beta-blocker Children: 0.15 mg/kg IV over
1 minute, followed by a 0.05-
Retyped by M. Magadia and H. C. Cutero
vomiting, abnormal in those dependent on
vision, headache, them.
pain at injection site, - Monitor for resedation.
increased sweating
- Monitor Headache, nausea, - Continue treatment
ethylene glycol dizziness, until ethylene glycol or
and methanol drowsiness, pain o methanol level is
levels injection site, <20mg/dL and the
- For ethylene hypotension, patient’s symptoms
glycol or increase or decrease have resolved including
methanol HR, diarrhea, a normal serum pH
poisoning, also agitation, drunk - For concomitant
monitor ABGs, feeling, facial flush, treatment with
UA, serum anxiety hemodialysis, see
osmolality (by package insert for
freezing point dosing instructions
depression), - Fomepizole inhibits the
calcium, renal elimination of ethanol.
function and Therefore, concomitant
anion gap administration of
ethanol with fomepizole
is not recommended as
toxic ethanol levels may
result
Glucose, Nausea, vomitiong - For continuous infusion,
potassium (especially with rapid mix glucagon with
infusion, hyper or normal saline or 5%
hypoglycemia, dextrose
hypokalemia, allergic - Serum half-life is only 8-
reaction 18 mins
 ANTIDOTE CHART
0.1 mg/kg/hr IV infusion
- May also be given IM
or SC but the IV
route is preferred
Ipecac Syrup GI decontamination - To aid GI Adults and adolescents: 15- None needed. Diarrhea, drowsiness, - Emesis usually begins
decontamination of 30 mL followed by 240 mL prolonged (>1hr) within 20 mins and may
a potentially toxic water vomiting last for 20-30 mins
substance in an - Avoid giving with milk or
alert, conscious Children (1-12y/o): 15 mL carbonated beverages
person with an preceded or followed by 120-
intact gag reflex 240 mL water
- Consider use only if - May repeat dose if emesis
it can be given does not occur in 20-30 mins
within 60 mins of
the ingestion
- Do not use for
hydrocarbons,
corrosive
substances,
strychnine,
nontoxic
substances,
calcium channel
blockers, beta-
blockers, clonidine,
digoxin or any
substance that can
produce coma or
seizures
Methylene blue Methemoglobin- Symptomatic patient - 1-2 mg/kg IV over 3-5 mins Methemoglobin Nausea, vomiting, - Blood sample with
producing drugs or with - Repeat dose if severely levels, ABGs, H/H, diarrhea, bladder methemoglobin m ay
poisons (i.e. nitrates, methemoglobinemia symptomatic patient does 02 sats irritation, blue-green show chocolate-colored
benzocaine, not respond in 15 mins or if discoloration of blood when allowed to
phenazopyridine, moderately symptomatic urine, and stool dry on filter paper
dapsone, aniline dyes) patient does not respond in - Methylene blue is
30-60 mins available as a 1%
solution
- Use with caution in
patients with G6PD

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 ANTIDOTE CHART
deficiency as hemolysis
may occur
- Use with caution in
treating aniline-induced
methemoglobinemia
due to risk of
precipitating Heinz body
formation and hemolytic
anemia

Naloxone Opioids Complete/partial Adults: 0.4-2 mg IV (2-3 Routine labs N/V, sweating, If no response after 10
reversal of narcotic minutes interval); For tachycardia, HTN, mg, question the
depression respiratory depression, initial tremulousness diagnosis of opioid toxicity
2 mg IV (2-5 minutes interval
or as needed) up to 10 mg; May precipitate
maybe given IM or SC if IV is withdrawal
not available

IV infusion: 0.4-0.8 mg/h for

recurrent cardiorespiratory
symptoms

Children: 0.01 mg/kg IV.

Subsequent 0.1 mg/kg IV if
needed
Octreotide Sulfonylureas Hypoglycemia Adults: 50-100 mg SC q6-12 h Serum glucose N/V, fatigue, edema, Use with dextrose
(Sandostatin) until hypoglycemia resolves flushing, HA,
dizziness, diarrhea,
Children: N/A abdominal pain,
injection site pain,
weakness
Phentolamine Extravasation of Extravasation of Adults: 5-10 mg Routine labs Weakness, dizziness, Most effective if within 12
(Regitine) vasoconstrictors vasoconstrictors tachycardia, h from time of
Children: 0.1-0.2 mg/kg (max hypotension extravasation. Ineffective
of 10 mg); Dilute in 10-15 mL if 24 h after.
of NSS, infiltrate site including
0.5 inch around periphery
Physostigmine Anticholinergics Reversal of effects Adults: 0.5-2 mg slowly IV (<1 Routine labs Seizures, cholinergic Use very cautiously.
caused by mg/min); Repeat q 10m until crisis, Use only when patient has

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 ANTIDOTE CHART
anticholinergics. Do resolved bradyarrhythmia, central/peripheral
not use with TCA asystole, N/V, anticholinergic sx.
poisoning Children: 0.02 mg/kg slowly salivation Give slowly.
IV (<0.5 mg/min); Repeat q5-
10m until there is effect or 2
mg is achieved

May be IM
Phytonadione/K1 Coumarin/Indanediones Excessive Adults: PT, PTT, INR Flushing, dizziness, Not effective for heparin.
anticoagulation by SC: 5-10 mg q6-8h altered taste, rapid IV only if other routes are
coumarin or PO: 10-25 mg/d weak pulse, not available.
indanediones IV: 10-50 mg sweating, Onset 1-2 h
hypotension,
Children: dyspnea, cyanosis,
SC: 1-5 mg q6-8h injection site pain,
PO: 5-10 mg/d anaphylactoid,
IV: 0.6 mg/kg death, VF

SC is preferred. Avoid IM.

Switch to PO for
maintenance.

PEG electrolyte GI decontamination Whole bowel Adults: 1500-2000 mL/h Routine labs N/V, abdominal pain, Best through NGT.
(GoLYTELY) irrigation for toxic Children 6 y -12 y: 1000 mL/h bloating Ensure airway is
ingestions Children 9 months – 6 y: 500 protected.
mL/h

Continue until rectal effluent

is clear
Pralidoxime/2- Organophosphates Tx of severe Adults: 1-2 g IV Serum Dizziness, Efficacy is time-dep.
PAM (Protopam) organophosphate cholinesterase drowsiness, blurred Best if given within 24-48
poisoning in Children: 25-50mg/kg IV vision, diplopia, HA, h
conjunction with N, tachycardia, Use with atropine
atropine 15-30 m infusion in 100 mL muscle weakness,
NSS HTN,
Give second dose if muscle hyperventilation
weakness is still present

Maintenance infusion:

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 ANTIDOTE CHART

Adults: 200-500 mg/h

Children: 5-20 mg/kg/h

Protamine Heparin Reversal of 1 mg = 90 u of heparin aPTT Hypotension, T½ of protamine is shorter
sulfate anticoagulant effect Slowly IV over 10 m. bradycardia, flushing, than heparin so recurrent
of heparin dyspnea, N/V, bleeding may occur.
If immediately after heparin: hypersensitivity
1-1.5 mg for 100u (max 50
mg)

If 30-60 min after: 0.5-0.75

mg for 100u

If 2 or more h after: 0.25-

0.375 mg for 100u

If heparin as constant
infusion: 25-50 mg

Pyridoxine (B6) INH, Tx for symptomatic IV over 5 min Routine labs Sensory neuropathy, Gyromitra spp. are false
monomethylhydrazine patients from INH or unstable gait, morels
(Gyromitra mushroom) Gyromitra mushroom INH: Dose should equal INH paresthesia,
dose. If unknown, 6 g for photoallergic
adults and 0.75mg/kg for
children

Mushroom: 20-30 mg/kg or 5

g; repeat if with seizures or in
comatose
Succimer/DMSA Pb, As, Hg Tx of Pb poisoning First 5 d: 10mg/kg (350 Serum lead (once N/V, diarrhea, loss of Pb levels may rebound 2-4
2
(Chemet) (45 mcg/dL or more) mg/m ) PO TID a week) until appetite, metallic wk after cessation of
stable taste, rash, elevated therapy.
Next 14 d: 10mg/kg (250 ALT/AST Repeat tx with 1-wk
2
mg/m ) PO BID WBC, LFT interval between tx.

Retyped by M. Magadia and H. C. Cutero