Common Drugs and Antidotes

Antidote Indication Mode of Action

Acetaminophen/ Tylenol/ Restores depleted glutathione stores and protects against

acetylcysteine (Mucomyst)
Activated charcoal
Paracetamol renal and hepatic failure.
Non-specific poisons except Absorption of drug in the gastric and intestinal tracts.
cyanide, iron, lithium, caustics and Interrupts the entero-hepatic cycle with multiple dose.
alcohol.

albuterol inhaler, insulin & glucose,

Potassium
NaHCO3, kayexalate

Neuromuscular blockade
anticholinesterase agents
(paralytics)
atropine sulfate or pralidoxime Anticholinesterase Competitive inhibition of muscarinic receptors.

Not known; partial protection against acute hepatic failure;

Amanita phalloides (Death cap may displace amatoxin from protein-binding sites allowing
Benzylpenicillin
mushroom) increased renal excretion; may also inhibit penetration of
amatoxin to hepatocytes.
Calcium salts Fluoride ingestion Rapidly complexes with fluoride ion.

Deferoxamine acts by binding free iron in the bloodstream and

deferoxamine Iron
enhancing its elimination in the urine.
Binds molecules of digoxin, making them unavailable for
digibind binding at their site of action on cells in the body.
Digoxin
digoxine immune fab

dimercapol, edetate calcium, Chelation of lead ions and endogenous metals (e.g., zinc,
Lead
disodium, manganese, iron, copper).
diphenhydramine (Benadryl) Extrapyramidal symptoms (EPS) A potent antagonist to acetylcholine in muscarinic receptors.

Reverses the effects of benzodiazepines by competitive

flumazenil Benzodiazepines inhibition at the benzodiazepine binding site on the GABAA
receptor.
A competitive inhibitor of the enzyme alcohol dehydrogenase
fomepizole Ethylene glycol found in the liver. This enzyme plays a key role in the
metabolism of ethylene glycol and methanol.
Stimulates the formation of adenyl cyclase causing
Beta blockers and calcium channel
glucagon intracellular increase in cycling AMP and enhanced
blockers
glycogenolysis and elevated serum glucose concentration.
Dextrose (the monosaccharide glucose) is used, distributed
Glucose (Dextrose 50%) Insulin reaction and stored by body tissues and is metabolized to carbon
dioxide and water with the release of energy.
Reverses hypercoagulable state by interacting with
antithrombin III. Used in combination with vasodilator
Heparin Ergotamine
phentolamine or nitroprusside to prevent local thrombosis and
ischemia.
Forms cyanocobalamin, a non-toxic metabolite that is easily
Hydroxocobalamin Cyanide
excreted through the kidneys.
Fluorouracil
leucovorin calcium
Protects the healthy cells from the effects of methotrexate
Methotrexate
while allowing methotrexate to enter and kill cancer cells.
Magnesium sulfate calcium gluconate

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 A “chemoprotectant” drug that reduces the undesired effects
mesna Cyclophosphamide
of certain chemotherapy drugs.
Chemical producing severe Reduces methemoglobin to hemoglobin.
Methylene blue methemoglobinemia. Ifosamide-
induced encephalopathy.
Prevents or reverses the effects of opioids including
nalmefene or naloxone Opioid analgesics
respiratory depression, sedation and hypotension.
Naloxone is believed to antagonize opioid effects by
naloxone (Narcan) Narcotics competing for the µ, κ and σ opiate receptor sites in the CNS,
with the greatest affinity for the µ receptor.
Anticholinesterase which causes accumulation of
Neostigmine Anticholinergics
acetylcholine at cholinergic receptor sites.
Oxidizes hemoglobin to methemoglobin which binds the free
Nitrite, sodium and glycerytrinitrate Cyanide cyanide and can enhance endothelial cyanide detoxification
by producing vasodilation.
Copper, gold, lead, mercury, zinc, Chelation of metal ions.
Penicillamine
arsenic
Regitine produces an alpha-adrenergic block of relatively
short duration. It also has direct, but less marked, positive
phentolamine (Regitine) Dopamine
inotropic and chronotropic effects on cardiac muscle and
vasodilator effects on vascular smooth muscle.
A reversible anticholinesterase which effectively increases the
phyostigmine or NaHCO3 Tricyclic antidepressants concentration of acetylcholine at the sites of cholinergic
transmission.
Phytomenadione (Vitamin K.) Coumadin/Warfarin Bypasses inhibition of Vitamin K epoxide reductase enzyme.

Protamine that is strongly basic combines with acidic heparin

protamine sulfate Heparin forming a stable complex and neutralizes the anticoagulant
activity of both drugs.
Isoniazid, theophylline, monomethyl Reverses acute pyridoxine deficiency by promoting GABA
Pyridoxine hydrazine. Adjunctive therapy in synthesis. Promotes the conversion of toxic metabolite
ethylene glycol poisoning. glycolic acid to glycine.

Neutralizes venom by binding with circulating venom

Snake anti-venin Cobra bite components and with locally deposited venom by
accumulating at the bite site.

Iron Prevents convertion of ferrous to ferric.

Cardiotoxic drug affecting fast Decreases affinity of cardiotoxic drugs to the fast sodium
sodium channel (TCA, cocaine) channel.
Sodium Bicarbonate
Weak acids Promotes ionization of weak acids.

Neutralization of hydrochloric acid formed when chlorine gas

Chlorine gas inhalational poisoning
Sodium thiosulphate Cyanide
Alcohol, Wernicke-Korsakoff
Syndrome
Thiamine
Adjunctive in ethylene glycol
reacts with water in the airways.
Replenishes depleted thiosulphate stores by acting as sulfur
donor necessary for the conversion of CN-O to thiocyanate
through the action of sulfur transferase enzyme rhodanese.
Reverses acute thiamine deficiency
Enhances detoxification of glyoxylic acid.

Chemicals causing Reduces methemoglobin to hemoglobin.

Vitamin C methemoglobinemia in patients with
G6PD deficiency

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