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Antidote
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Indication
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Mode of Action
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acetylcysteine (Mucomyst)
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Acetaminophen/ Tylenol/ Paracetamol
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Restores depleted glutathione stores and protects against renal and hepatic failure.
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Activated charcoal
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Non-specific poisons except cyanide, iron, lithium, caustics and alcohol.
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Absorption of drug in the gastric and intestinal tracts. Interrupts the entero-hepatic cycle with multiple dose.
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albuterol inhaler, insulin & glucose, NaHCO3, kayexalate
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Potassium
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anticholinesterase agents
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Neuromuscular blockade (paralytics)
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atropine sulfate or pralidoxime
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Anticholinesterase
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Competitive inhibition of muscarinic receptors.
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Benzylpenicillin
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Amanita phalloides (Death cap mushroom)
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Not known; partial protection against acute hepatic failure; may displace amatoxin from protein-binding sites allowing increased renal excretion; may also inhibit penetration of amatoxin to hepatocytes.
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Calcium salts
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Fluoride ingestion
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Rapidly complexes with fluoride ion.
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deferoxamine
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Iron
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Deferoxamine acts by binding free iron in the bloodstream and enhancing its elimination in the urine.
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digibind
digoxine immune fab
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Digoxin
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Binds molecules of digoxin, making them unavailable for binding at their site of action on cells in the body.
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dimercapol, edetate calcium, disodium,
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Lead
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Chelation of lead ions and endogenous metals (e.g., zinc, manganese, iron, copper).
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diphenhydramine (Benadryl)
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Extrapyramidal symptoms (EPS)
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A potent antagonist to acetylcholine in muscarinic receptors.
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flumazenil
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Benzodiazepines
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Reverses the effects of benzodiazepines by competitive inhibition at the benzodiazepine binding site on the GABAA receptor.
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fomepizole
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Ethylene glycol
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A competitive inhibitor of the enzyme alcohol dehydrogenase found in the liver. This enzyme plays a key role in the metabolism of ethylene glycol and methanol.
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glucagon
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Beta blockers and calcium channel blockers
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Stimulates the formation of adenyl cyclase causing intracellular increase in cycling AMP and enhanced glycogenolysis and elevated serum glucose concentration.
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Glucose (Dextrose 50%)
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Insulin reaction
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Dextrose (the monosaccharide glucose) is used, distributed and stored by body tissues and is metabolized to carbon dioxide and water with the release of energy.
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Heparin
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Ergotamine
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Reverses hypercoagulable state by interacting with antithrombin III. Used in combination with vasodilator phentolamine or nitroprusside to prevent local thrombosis and ischemia.
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Hydroxocobalamin
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Cyanide
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Forms cyanocobalamin, a non-toxic metabolite that is easily excreted through the kidneys.
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leucovorin calcium
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Fluorouracil
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Methotrexate
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Protects the healthy cells from the effects of methotrexate while allowing methotrexate to enter and kill cancer cells.
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Magnesium sulfate
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calcium gluconate
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mesna
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Cyclophosphamide
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A “chemoprotectant” drug that reduces the undesired effects of certain chemotherapy drugs.
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Methylene blue
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Chemical producing severe methemoglobinemia. Ifosamide-induced encephalopathy.
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Reduces methemoglobin to hemoglobin.
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nalmefene or naloxone
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Opioid analgesics
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Prevents or reverses the effects of opioids including respiratory depression, sedation and hypotension.
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naloxone (Narcan)
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Narcotics
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Naloxone is believed to antagonize opioid effects by competing for the µ, ? and ? opiate receptor sites in the CNS, with the greatest affinity for the µ receptor.
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Neostigmine
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Anticholinergics
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Anticholinesterase which causes accumulation of acetylcholine at cholinergic receptor sites.
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Nitrite, sodium and glycerytrinitrate
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Cyanide
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Oxidizes hemoglobin to methemoglobin which binds the free cyanide and can enhance endothelial cyanide detoxification by producing vasodilation.
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Penicillamine
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Copper, gold, lead, mercury, zinc, arsenic
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Chelation of metal ions.
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phentolamine (Regitine)
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Dopamine
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Regitine produces an alpha-adrenergic block of relatively short duration. It also has direct, but less marked, positive inotropic and chronotropic effects on cardiac muscle and vasodilator effects on vascular smooth muscle.
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phyostigmine or NaHCO3
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Tricyclic antidepressants
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A reversible anticholinesterase which effectively increases the concentration of acetylcholine at the sites of cholinergic transmission.
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Phytomenadione (Vitamin K.)
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Coumadin/Warfarin
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Bypasses inhibition of Vitamin K epoxide reductase enzyme.
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protamine sulfate
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Heparin
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Protamine that is strongly basic combines with acidic heparin forming a stable complex and neutralizes the anticoagulant activity of both drugs.
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Pyridoxine
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Isoniazid, theophylline, monomethyl hydrazine. Adjunctive therapy in ethylene glycol poisoning.
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Reverses acute pyridoxine deficiency by promoting GABA synthesis. Promotes the conversion of toxic metabolite glycolic acid to glycine.
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Snake anti-venin
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Cobra bite
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Neutralizes venom by binding with circulating venom components and with locally deposited venom by accumulating at the bite site.
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Sodium Bicarbonate
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Iron
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Prevents convertion of ferrous to ferric.
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Cardiotoxic drug affecting fast sodium channel (TCA, cocaine)
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Decreases affinity of cardiotoxic drugs to the fast sodium channel.
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Weak acids
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Promotes ionization of weak acids.
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Chlorine gas inhalational poisoning
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Neutralization of hydrochloric acid formed when chlorine gas reacts with water in the airways.
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Sodium thiosulphate
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Cyanide
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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.
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Thiamine
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Alcohol, Wernicke-Korsakoff Syndrome
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Reverses acute thiamine deficiency
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Adjunctive in ethylene glycol
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Enhances detoxification of glyoxylic acid.
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Vitamin C
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Chemicals causing methemoglobinemia in patients with G6PD deficiency
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Reduces methemoglobin to hemoglobin.
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