Health Authority – Abu Dhabi ‫أبوظبي‬- ‫هــيئـــــةالصحة‬

Title: HAAD Standard for Antidote Stock Issue Date: May 2011
Reference: PHP/PHM/PIC-1/V 1.0 Next Review Date: June 2013

1. Purpose
1.1 This Standard mandates the requirement to stock and maintain adequate supply of specified
antidotes and to report on stocks of specified antidotes to ensure the continuous, safe
access to and use of antidotes by healthcare providers.

2. Scope
2.1 This standard applies to all HAAD licensed healthcare facilities with Emergency Service
Departments and professionals engaged in providing emergency care in the Emirate of Abu
Dhabi.
2.2 It covers cases of poisoning by chemical substances only; poisoning by radiation must be
reported to the HAAD Operations Centre and referred to specified facilities of the UAE
Armed Forces.

3. Duties of Healthcare Facilities with Emergency Services

3.1 All healthcare providers engaged in providing emergency services must:
3.1.1 Maintain continuous supply of, safe access to and use of stocks of antidotes as
specified in the HAAD List of antidotes provided at Appendix 1;
3.1.2 Maintain a minimum stock amount of each antidote sufficient to treat a 70 kg adult
for the first 24 hours of admission for treatment, where indicated;
3.1.3 Report to HAAD on antidote stocks level on a monthly basis using the HAAD
specified reporting form provdied at Appendix 2;
3.1.4 Establish policies and procedures for effective sharing of antidotes, inlcuding during
but not limited to stock shortages, with other healthcare facilities;
3.1.5 Ensure that appropriately licensed and privileged health professionals are
repsonsible for prescribing and administering antidotes, in accordance with their
competence and scope of practice;
3.1.6 Report any poisoning cases arising from exposure to radiation to HAAD Operations
Centre and cooperate with HAAD to facilitate the referral of such cases to the
sepcified facility(s) of the UAE Armed Forces;
3.1.7 Comply with HAAD policies and standards on managing patient medical records,
including developing effective recording systems, maintaining patient records,
protecting confidentiality, privacy and security of patient information and educating
patients as well as satisfying the requirements of patients rights and responsibilities
charter;
3.1.8 Maintain, and make available for HAAD audit, a list of antidotes administered and
stock levels;
3.1.9 Comply and cooperate with the HAAD authorised auditors, as required for
inspections and audits by HAAD.

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4. HAAD Role
4.1 The HAAD will
4.1.1 Determine the range of antidotes to be stocked, establish and review, from time to
time, the list of antidotes and levels to be maintained, used and monitored by
healthcare providers;
4.1.2 Collect and analyse data reported to HAAD to monitor and evaluate potential risks
of antidote shortages, monitor safe and quality use of antidotes and share
information and alerts with healthcare providers to facilitate adequate management
of risks, where necessary;
4.1.3 Ensure that potential or identified shortages of antidotes are managed promptly
and effectively to maintain safe and quality care;
4.1.4 Co-ordinate communications with local and international suppliers in cases of likely
stock shortages in order to facilitate providers with procuring antidotes, where
necessary; and
4.1.5 Coordinate with healthcare providers and the respective facilities of the UAE Armed
Forces to manage the referral of notified cases of poisoning by radiation.

5. Exemptions
5.1 HAAD may, at its sole discretion, exempt certain facilities from the requirement to maintain
in full the HAAD List of Antidotes (Appendix 1). Applications for exemption must be submitted in
writing to HAAD specifying the reasons for seeking an exemption and justifying how patient needs
and potential risks will be managed. Facilities exempted from the requirement to maintain in full
the HAAD List of antidotes are required to maintain a Basic List of antidotes to be specified by HAAD.
Where exemption is granted, Exemptions Basic List (Appendix 3) and Reporting Sheet apply
(Appendix 4).
5.2 An exemption granted by HAAD does not waive any of the duties, obligations and
resposnibilities of the facility under licence towards the patients it serves. The facility is responsible
for managing patient needs and any risks in repsect of the range of antidotes maintained by the
facility.
6. Enforcement and Sanctions
6.1 Where a healthcare provider is in breach of a duty under this Policy, HAAD may take any or all
of the following actions:
6.1.1 Issue a warning to the healthcare provider,
6.1.2 Suspend the license of the healthcare provider for a period of time that HAAD
determines to be appropriate in the circumstances of the case,
6.1.3 Require re-evaluation of the competence of the professional to practice as HAAD
determines to be appropriate in the circumstances of the case,
6.1.4 Revoke the license of the professional or healthcare provider.

6.2 HAAD may impose sanctions in relation to any breach of this Policy in accordance with the
[HAAD Policy on Enforcement and Sanctions]. Decisions on suspending and/or revoking of
licences will be determined by considering the circumstances of the case and consistent with the
terms and procedures of the HAAD Licensing Committee and in accordance with measures
under the law.

Appendix 1 - HAAD List of Antidotes

*Healthcare facilities must maintain a minimum stock of the following antidotes according to their
individual average of cases treated for any of the following indications. It is the responsibility of the
healthcare facility to ensure that stock levels to be maintained at the facility are not limited to the
“Minimum stock required“ as mentioned in this list.

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 Advanced Antidote list

Antidote Minimum stock to Indication Minimum

treat 1 patient (70 stock
kg) for the first 24 required*
hours

Atropine sulfate 1000 mg total Alpha-2 agonists (e.g. clonidine, guanabenz and Two patients
(vials) guanfacine), Alzheimer drugs (e.g. donepezil,
galantamine, rivastigmine, tacrine), antimyesthenic
agents (e.g. pyridostigmine), bradyarrhythmia-
producing agents (e.g. beta blockers, calcium channel
blockers and digitalis glycosides), cholinergic agonists
(e.g. bethanechol), muscarine-containing mushrooms
(e.g. Clitocybe and Inocybe sp), nerve agents (e.g.
sarin, soman, tabun and VX), organophosphate and
carbamate insecticides

Bromocriptine 30 mg total( 12 X Medications causing neuroleptic malignant syndrome One Patient

mesylate 2.5 mg) (NMS)(haloperidol, levodopa withdrawal

Calcium disodium 18000mg total Lead, zinc salts (e.g., zinc chloride) One Patient
EDTA (200mg/ml 5ml
amp) (= 18 amps)

Calcium gluconate 2.5 % (25 gm or 30 Hydrofluoric acid skin exposure One Patient
gel gm tube) total 4
tubes

Calcium gluconate 5 -10 vials ( 1 gm Calcium channel blockers, fluoride salts (e.g. NaF), Two Patients
INJ each) of 10% hyperkalemia (not digoxin-induced),
calcium gluconate hypermagnesemia

Charcoal 3 bottle of 50 gm Reduction of absorption of poisons in the gastro- Five Patients

intestinal system.

Cyanide antidote Two kits of Cyanide Acetonitrile, acrylonitrile, bromates (thiosulfate only), Two Patients
kit / or antidote or 5 g chlorates (thiosulfate only), cyanide (e.g. HCN, KCN
Hydroxycobolamine total (2.5 g vial) of and NaCN), cyanogen chloride, cyanogenic glycoside
hydroxycobalamine natural sources (e.g. apricot pits and peach pits),
hydrogen sulfide (nitrites only), laetrile mustard
agents (thiosulfate only), nitroprusside (thiosulfate
only), smoke inhalation (combustion of synthetic
materials)

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Cyproheptadine 100 tablets of 4 mg Serotonin syndrome One Patient

Dantrolene sodium 700mg total (35 x Malignant hyperpyrexia or muscular rigidity One Patient
20mg vial)

Deferoxamine 6000 mg total (12 x Iron overdose One Patient

mesylate 500 mg vial)

Benzodiazepines Supportive in the management of seizures , anxiety Five Patients

(Diazepam or due to poisoning (Diazepam for Chloroquine and
lorazepam) related antimalarial drugs over dose)

Digoxin immune 20 vials Cardiac glycoside-containing plants (e.g. foxglove and One Patient
Fab oleander), digitoxin, digoxin

Dimercaprol (BAL) 1800mg total (18 Arsenic, copper, gold, lead, lewisite, mercury One Patient
x50mg/ml -2ml
ampoules)

Diphenhydramine 500 mg total (10 X Drug-induced extrapyramidal symptoms (e.g. acute Five Patients
HCL 50mg/ml 5 vial) dystonic reactions)

Flumazenil(UK/US) 10 mg total (20 x Benzodiazepines, zaleplon, zolpidem One Patient

0.1mg/ml -5ml
vial)

Folinic acid 200 mg total (2 Methanol, methotrexate, trimetrexate, One Patient

(Leucovorin x10 mg/mL -10 mL pyrimethamine, trimethoprim
Calcium) vial)

Fomepizole 4 x 1.5ml (1g/ml) Ethylene glycol, methanol Two Patients

vials

Glucagon 100mg total ( 100 x Beta blockers, calcium channel blockers, One Patient
1mg vials ) hypoglycemia, hypoglycemic agents

Insulin (Reglular 2 vials of 10-mls Beta blockers, Calcium channel blockers Two Patients
Insulin) (diltiazem,nifedipine, verapamil)

L-Carnitine 7 gm total (7 x Valproic acid (hyperammonemia, encephalopathy, One Patient

200mg/ml - 5ml liver failure)
vial

Methylene blue 500 mg total (5 x Methemoglobin-inducing agents (e.g. aniline dyes, One Patient
10mg/ml - 10ml dapsone, dinitrophenol, benzocaine, licdocaine,
vial) metoclopramide, monomethylhyrdazine-containing,
mushrooms (e.g., Gyromitra), naphthalene, nitrates

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 and nitrites, nitrobenzene, phenazopyridine

N-Acetylcysteine 20 % solution, 21 Acetaminophen, carbon tetrachloride, other Two Patients

vials (10 ml each) hepatotoxins

Naloxone 30 mg total (75 x Opioids (e.g. codeine, dextromethorphan, Two Patients

0.4mg/ml - 1ml diphenoxylate, fentanyl, heroin, meperidine,
ampoule) morphine, diphenoxylate, buprenorphine,
pentazocine, and propoxyphene), possibly useful for:
alpha-2 agonists (e.g. clonidine, guanabenz, and
guanfacine), imidazoline decongestants
(e.g.,oxymetazoline and tetrahydrozoline), loperamide

Octreotide acetate 0.2 mg total ( 2 Sulfonylurea hypoglycemic agents (e.g. glipizide, One Patient
x 0.1mg/ml - 1ml glibenclamide), quinine induced hypoglycemia
ampoule)

Phentolamine 10mg total( Catecholamine extravasation, intradigital epinephrine One Patient

mesylate 1X10mg/ml-1ml injection
ampoule

Physostigmine 20mg Anticholinergic alkaloid-containing plants (e.g. deadly One Patient

salicylate total(10X1mg/ml-2 nightshade and jimson weed), antihistamines,
ml vials) atropine and other anticholinergic, intrathecal
baclofen

Phytonadione 100mg total (10 x Coumarin and Indandione derivatives, long-acting One Patient
(vitamin K1) 10 mg/ml 1 ml- anticoagulant, rodenticides (e.g. brodifacoum and
ampoule) bromadiolone), warfarin

Pralidoxime 12000 mg total (12 Cholinesterase inhibitor insecticides and nerve agents, Two Patients
chloride x 1000 mg vial) carbamates insecticides

Protamine sulfate 200 mg total (4 x Heparin, Low-Molecular -Weight heparin (LMWH) (e.g One Patient
10mg/ml - 5ml - Enoxaparin, Dalteparin, tinazaparin)
ampoule)

Pyridoxine 20000mg total (20 Isoniazide, Hydrazine,Gyromitra mushrooms. Adjunct One Patient
x 100mg/ ml to therapy for ethylene glycol intoxication.
10ml- vial)

Red back spider Two vials of 500 One Patient

antiserum units lyophilized
antivenom

Snake Antivenom 4-5 vials of the Snake bites: ; 40-50 ml (fixed dose) of the antivenom is Two Patients
Saudi National to be diluted in
Antivenom and

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 Vaccine Production 5ml normal saline / kg body weight, and to be infused
Center intravenously over a period of 30-60 minutes. This
dose can be repeated every 4-6

hours until definite improvement of the signs

Sodium 500 mEq total (10 Chlorine gas, Hyperkalemia, Serum Two Patients
bicarbonate x1mEq/ml (8.4%) - Alkalinization:Agents producing a quinidine-like effect
50ml-vial) as noted by widened QRS complex on EKG (e.g.,
amantadine,carbamazepine, chloroquine,cocaine,
diphenhydramine, flecainide,propafenone,
propoxyphene,tricyclic antidepressants, quinidine)
Urine Alkalinization:Weakly acidic agents
(e.g.,chlorophenoxy herbicides,chlorpropamide,
phenobarbital and salicylates)

Thiamine 1 gm total (5 x Ethanol, Ethylene glycol One Patient

100mg/ml - 2ml
ampoule)

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Appendix 2 - Reporting sheet for HAAD Advanced List of Antidotes

Minimum stock to treat 1

Antidote patient (70 kg) for the first 24 Current Stock Level Hospital Name:
hours
Atropine sulfate 1000 mg total (vials) Date:

Bromocriptine 30 mg total( 12 X 2.5 mg) Name:

mesylate
Calcium disodium EDTA 18000mg total (200mg/ml E mail
5ml amp) (= 18 amps)
Calcium gluconate gel 2.5 % (25 gm or 30 gm tube) Telephone:
total 4 tubes direct line
Calcium gluconate INJ 5 -10 vials ( 1 gm each) of 10% Mobile #
calcium gluconate
Charcoal 3 bottles of 50gm Fax #
Cyanide antidote kit or Two kits of Cyanide antidote
Hydroxycobalamine or 5 g total (2.5 g vial) of
hydroxycobalamine
Cyproheptadine 100 tablets of 4 mg
Dantrolene sodium 700mg total (35 x 20mg vial)
Deferoxamine 6000 mg total (12 x 500 mg
mesylate vial
Benzodiazepines Diazepam or lorazepam
Digoxin immune Fab 20 vials
Dimercaprol (BAL) 1800mg total (18 x50mg/ml -
2ml ampoules)
Diphenhydramine HCL 500 mg total (10 X 50mg/ml 5
vial)
Flumazenil(UK/US) 10 mg total (20 x 0.1mg/ml -
5ml vial)
Folinic acid (Leucovorin 200 mg total (2 x10 mg/mL -
Calcium) 10 mL vial)
Fomepizole 4 x 1.5ml (1g/ml) vials
Glucagon 100mg total ( 100 x 1mg vials )
Insulin (Regular Insulin) 2 vials of 10-mls

L-Carnitine 7 gm total (7 x 200mg/ml -

5ml vial
Methylene blue 500 mg total (5 x 10mg/ml -
10ml vial)

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N-Acetylcysteine 20 % solution, 21 vials (10 ml
each)
Naloxone 30 mg total (75 x 0.4mg/ml -
1ml ampoule)
Octreotide acetate 0.2 mg total ( 2 x 0.1mg/ml -
1ml ampoule)
Phentolamine mesylate 10 mg total (1 x 10mg/ml -1ml
ampoule)
Physostigmine 20mg total (10X1mg/ml- 2ml
salicylate vials)
Phytonadione (vitamin 100mg total (10 x 10 mg/ml 1
K1) ml-ampoule)
Pralidoxime chloride 12000
mg total (12 x 1000 mg vial)
Protamine sulfate 200 mg total (4 x 10mg/ml -
5ml -ampoule)
Pyridoxine 20000mg total (20 x 100mg/
ml 10ml- vial)
Red back spider Two vials of 500 units
antiserum lyophilized antivenom
Snake Antivenom 4-5 vials of the Saudi National
Antivenom and Vaccine
Production Center

Sodium bicarbonate 500 mEq total (10 x1mEq/ml

(8.4%) - 50ml-vial)
Thiamine 1 gm total (5 x 100mg/ml -
2ml ampoule)

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Appendix 3 – Exemption Basic List of Antidotes
Healthcare providers must not use this “Exemption Basic List of Antidotes” unless granted an exemption to do so by
HAAD; exemptions must be sought in writing and are subject to the satisfying the HAAD requirements and approval.
*Healthcare facilities granted an exemption must maintain a minimum stock of the following antidotes according to
their individual average of cases treated for any of the following indications. It is the responsibility of the healthcare
facility to ensure that stock levels to be maintained at the facility are not limited to the “Minimum stock required“ as
mentioned in this list.

Basic Antidote list

Antidote Minimum stock to Indication Minimum
treat 1 patient (70 stock
kg) for the first 24 required *
hours

Atropine sulfate 500mg total (vials) Alpha-2 agonists (e.g. clonidine, guanabenz and One
guanfacine), Alzheimer drugs (e.g. donepezil, patients
galantamine, rivastigmine, tacrine), antimyesthenic
agents (e.g. pyridostigmine), bradyarrhythmia-producing
agents (e.g. beta blockers, calcium channel blockers and
digitalis glycosides), cholinergic agonists (e.g.
bethanechol), muscarine-containing mushrooms (e.g.
Clitocybe and Inocybe sp), nerve agents (e.g. sarin,
soman, tabun and VX), organophosphate and carbamate
insecticides
Calcium gluconate 2.5 % (25 gm or 30 Hydrofluoric acid skin exposure One patient
gel gm tube) total 4
tubes

Calcium gluconate 5 -10 vials ( 1 gm Calcium channel blockers, fluoride salts (e.g. NaF), Two patients
INJ each) of 10% hyperkalemia (not digoxin-induced), hypermagnesemia
calcium gluconate

Charcoal 3 bottle of 50gm Reduction of absorption of poisons in the gastro-intestinal Five patients
system.
Cyanide antidote kit Two kits of Cyanide Acetonitrile, acrylonitrile, bromates (thiosulfate only), Two Patients
/ or antidote or 5 g chlorates (thiosulfate only), cyanide (e.g. HCN, KCN and
Hydroxycobolamine total (2.5 g vial) of NaCN), cyanogen chloride, cyanogenic glycoside natural
hydroxycobalamine sources (e.g. apricot pits and peach pits), hydrogen sulfide
(nitrites only), laetrile mustard agents (thiosulfate only),
nitroprusside (thiosulfate only), smoke inhalation
(combustion of synthetic materials)
Benzodiazepines Supportive in the management of seizures , anxiety due to Five
(Diazepam or poisoning (Diazepam for Chloroquine and related patients
lorazepam) antimalarial drugs over dose)
Dantrolene sodium 700mg total (35 x Malignant hyperpyrexia or muscular rigidity One Patient
20mg vial)

Diphenhydramine 500 mg total (10 X Drug-induced extrapyramidal symptoms (e.g. acute Five
50mg/ml 5 vial) dystonic reactions) patients
Flumazenil 10 mg total (20 x Benzodiazepines, zaleplon, zolpidem One patient
0.1mg/ml -5ml vial)
Glucagon 50mg total ( 50 x Beta blockers, calcium channel blockers, hypoglycemia, One patient
1mg vials ) hypoglycemic agents

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Methylene blue 500 mg total (5 x Methemoglobin-inducing agents (e.g. aniline dyes, One patient
10mg/ml - 10ml dapsone, dinitrophenol, benzocaine, licdocaine,
vial) metoclopramide, monomethylhyrdazine-containing,
mushrooms (e.g., Gyromitra), naphthalene, nitrates and
nitrites, nitrobenzene, phenazopyridine
N-Acetylcysteine 20 % solution, 21 Acetaminophen, carbon tetrachloride, other hepatotoxins Two patients
vials (10 ml each
Naloxone 30 mg total (75 x Opioids (e.g. codeine, dextromethorphan, diphenoxylate, Two patients
0.4mg/ml - 1ml fentanyl, heroin, meperidine, morphine, diphenoxylate,
ampoule) buprenorphine, pentazocine, and propoxyphene),
possibly useful for: alpha-2 agonists (e.g. clonidine,
guanabenz, and guanfacine), imidazoline decongestants
(e.g.,oxymetazoline and tetrahydrozoline), loperamide
Phentolamine 10mg total Catecholamine extravasation, intradigital epinephrine One patient
mesylate (1X10mg/ml - 1ml injection
ampoule)
Sodium bicarbonate 500 mEq total (10 Chlorine gas, Hyperkalemia, Serum Alkalinization:Agents Two
x1mEq/ml (8.4%) - producing a quinidine-like effect as noted by widened patient s
50ml-vial) QRS complex on EKG (e.g., amantadine,carbamazepine,
chloroquine,cocaine, diphenhydramine,
flecainide,propafenone, propoxyphene,tricyclic
antidepressants, quinidine) Urine Alkalinization:Weakly
acidic agents (e.g.,chlorophenoxy
herbicides,chlorpropamide, phenobarbital and salicylates)

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 Appendix 4 - Reporting Antidote Sheet for basic list

Antidote Minimum stock to treat 1 Current Stock Hospital name

patient (70 kg) for the first Level
24 hours

Atropine sulfate 500mg total (vials) Date

Calcium gluconate gel 2.5 % (25 gm or 30 gm Contact details

tube) total 4 tubes
Calcium gluconate INJ 5 -10 vials ( 1 gm each) of Name:
10% calcium gluconate

Charcoal 3 bottles 50 gm E mail

Cyanide antidote kit or Two kits of Cyanide Telephone: direct
Hydroxycobalamine antidote or 5 g total (2.5 g line
vial) of hydroxycobalamine
Benzodiazepines Mobile #
(Diazepam or
lorazepam)
Dantrolene sodium 700mg total (35 x 20mg Fax #
vial)
Diphenhydramine 500 mg total (10 X
50mg/ml 5 vial)
Flumazenil 10 mg total (20 x 0.1mg/ml
-5ml vial)
Glucagon 50mg total ( 50 x 1mg vials )

Methylene blue 500 mg total (5 x 10mg/ml

- 10ml vial)
N-Acetylcysteine 20 % solution, 21 vials (10
ml each
Naloxone 30 mg total (75 x 0.4mg/ml
- 1ml ampoule)
Phentolamine 10 mg total (1x 10mg/ml -
mesylate 1ml ampoule)
Sodium bicarbonate 500 mEq total (10
x1mEq/ml (8.4%) - 50ml-
vial)

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