Common Drugs and Their Antidotes

An antidote is a substance that can counteract a form of poisoning. The

term antidote is a Greek word meaning “given against”. This post will help
you familiarize yourself with the common antidotes that are used in the
hospital setting. The following are antidotes that should be familiarized by
the nurse to respond to this emergency situation quickly.
 Antidote Indication Mode of Action

Restores depleted glutathione

Acetaminophen/
acetylcysteine (Mucomyst) stores and protects against
Tylenol/ Paracetamol
renal and hepatic failure.

Non-specific poisons Absorption of drug in the

except cyanide, iron, gastric and intestinal tracts.
Activated charcoal
lithium, caustics and Interrupts the entero-hepatic
alcohol. cycle with multiple dose.

albuterol inhaler, insulin & glucose,

Potassium
NaHCO3, kayexalate

Neuromuscular
anticholinesterase agents
blockade (paralytics)

Competitive inhibition of
atropine sulfate or pralidoxime Anticholinesterase
muscarinic receptors.

Not known; partial protection

against acute hepatic failure;
Amanita phalloides may displace amatoxin from
Benzylpenicillin (Death cap protein-binding sites allowing
mushroom) increased renal excretion; may
also inhibit penetration of
amatoxin to hepatocytes.

Rapidly complexes with

Calcium salts Fluoride ingestion
fluoride ion.

Deferoxamine acts by binding

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

Chelation of lead ions and

dimercapol, edetate calcium,
Lead endogenous metals (e.g., zinc,
disodium,
manganese, iron, copper).

A potent antagonist to
Extrapyramidal
diphenhydramine (Benadryl) acetylcholine in muscarinic
symptoms (EPS)
receptors.

Reverses the effects of

benzodiazepines by
flumazenil Benzodiazepines competitive inhibition at the
benzodiazepine binding site
on the GABAA receptor.

A competitive inhibitor of the

enzyme alcohol
dehydrogenase found in
fomepizole Ethylene glycol
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
intracellular increase in cycling
glucagon calcium channel
AMP and enhanced
blockers
glycogenolysis and elevated
serum glucose concentration.
 Dextrose (the monosaccharide
glucose) is used, distributed
and stored by body tissues
Glucose (Dextrose 50%) Insulin reaction
and is metabolized to carbon
dioxide and water with the
release of energy.

Reverses hypercoagulable
state by interacting with
antithrombin III. Used in
Heparin Ergotamine combination with
vasodilator phentolamine or
nitroprusside to prevent
local thrombosis and ischemia.

Forms cyanocobalamin, a
non-toxic metabolite that is
Hydroxocobalamin Cyanide
easily excreted through the
kidneys.

Fluorouracil

Protects the healthy cells from

leucovorin calcium
the effects of methotrexate
Methotrexate
while allowing methotrexate to
enter and kill cancer cells.

Magnesium sulfate calcium gluconate

A “chemoprotectant” drug that

reduces the undesired effects
mesna Cyclophosphamide
of certain chemotherapy
drugs.
 Chemical producing
severe
Reduces methemoglobin
Methylene blue methemoglobinemia.
to hemoglobin.
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
competing for the µ, κ and σ
naloxone (Narcan) Narcotics
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.

Nitrite, sodium and glycerytrinitrate
Oxidizes hemoglobin to
methemoglobin which binds
the free cyanide and can
Cyanide
enhance endothelial cyanide
detoxification by producing
vasodilation.

Copper, gold, lead,

Penicillamine mercury, zinc, Chelation of metal ions.
arsenic

phentolamine (Regitine)
Regitine produces an alpha-
adrenergic block of relatively
short duration. It also has
direct, but less marked,
Dopamine positive inotropic and
chronotropic effects on
cardiac muscle and
vasodilator effects on vascular
smooth muscle.

A reversible anticholinesterase
which effectively increases the
Tricyclic
phyostigmine or NaHCO3 concentration of acetylcholine
antidepressants
at the sites of cholinergic
transmission.

Bypasses inhibition of Vitamin

Phytomenadione (Vitamin K.) Coumadin/Warfarin
K epoxide reductase enzyme.

Protamine that is strongly

protamine sulfate
basic combines with
acidic heparin forming a stable
Heparin
complex and neutralizes the
anticoagulant activity of both
drugs.

Isoniazid,
Reverses acute pyridoxine
theophylline,
deficiency by promoting GABA
monomethyl
Pyridoxine synthesis. Promotes the
hydrazine. Adjunctive
conversion of toxic metabolite
therapy in ethylene
glycolic acid to glycine.
glycol poisoning.
 Neutralizes venom by binding
with circulating venom
Snake anti-venin Cobra bite components and with locally
deposited venom by
accumulating at the bite site.

Prevents convertion of ferrous

Iron
to ferric.

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

Neutralization of hydrochloric
Chlorine gas
acid formed when chlorine gas
inhalational
reacts with water in the
poisoning
airways.

Replenishes depleted
thiosulphate stores by acting
as sulfur donor necessary for
Sodium thiosulphate Cyanide the conversion of CN-O to
thiocyanate through the action
of sulfur transferase enzyme
rhodanese.

Alcohol, Wernicke- Reverses acute thiamine

Thiamine
Korsakoff Syndrome deficiency
 Adjunctive in Enhances detoxification of
ethylene glycol glyoxylic acid.

Chemicals causing
methemoglobinemia Reduces methemoglobin to
Vitamin C
in patients with hemoglobin.
G6PD deficiency