Antidotes to Common Poisons:

NAC(N-acetylcysteine) Physostigmine Vitamin K1, protamine. Supportive Care, Flumazenil* Botulinum Antitoxin Glucagon Calcium, ?Glucagon? Atropine, Pralodixime in Organophosphate Cholinergics Overdose Carbon Monoxide Oxygen, Hyperbaric Oxygen Amyl Nitrate, Sodium Nitrate, Sodium Cyanide Thiosulfate, Hydroxycobalamin (Available in Europe). Digoxin Digoxin Fab Antibodies Iron Deferoxamine Isoniazid Pyridoxine Lead BAL, EDTA, DMSA Methemoglobinemia Methelene Blue Opiods Naloxone Ethanol Drip, Dialysis. Experimental trials Toxic Alcohols underway on Enzyme Inhibitors. Tricyclic Antidepressants Sodium Bicarbonate *Use of flumazenil contraindicated in many situations including tricyclic overdose or in chronically habituated benzodiazepine users, as this may precipitate seizures. Poisons & Antidotes Acetanilid (antifebrin) Acids Corrosive Aconite Alcohol Alkalies, Corrosive Ammonia Antipyrine Arsenic Atropine Barbital Group Barium and its Salts Camphor Gelsemium Hydrocyanic Acid Iodine Lead Lobelia Mercuric Salts Nitric Acid - See Acids, Corrosive Nitroglycerin Opium Oxalic Acid Paris Green, Rough on Rats - See Arsenic Phenol - See Carbolic Acid Poison---------------------------------Antidote Acetominophen Anticholinergics Anticoagulants (warfarin/coumadin,heparin) Benzodiazepines Botulism Beta Blockers Calcium Channel Blockers

Cantharides Carbolic Acid Carbon Monoxide Chloral Chloroform Cocaine Colchicum Conium Copper Corrosive Sublimate - See Mercuric Salts Croton Oil Digitalis Ergot Antidote N-acetylcysteine (NAC) 20%, 30 mL, po Mucomyst (Apothecon; Plainsboro, NJ) or equivalent N-acetylcysteine (NAC) 20%, 30 mL, IV Acetadote Antivenin CroFab; [crotalidae polyvalent immune Fab (Ovine); Protherics PLC; Cheshire, UK) Antivenin (Latrodectus mactans) Indication by Substance Acetaminophen

Phenacetin - See Antipyrine Phosphorus Physostigma Picrotoxin Strophanthus - See Digitalis Strychnine Sulfonal, Trional Tansy Oil Tartar Emetic Tobacco Veratrum Viride Zinc Salts Stocking Standard 7 vials Comments Dilute by at least a 3:1 ratio

Acetaminophen

1 carton of 4 vials

Infuse loading dose slowly over 45-60 min

Rattlesnake

24 vials

Black widow spider

1 vial

Carnitine (LHyperammonemia carnitine), Carnitor from valproic acid (Sigma-Tau Pharmaceuticals; Gaithersburg, MD), 1g Cyanide antidote package Cyanide and cyanogenic glycoside

7 vials

2 kits or stock Cyanokit (see

Thiosulfate component can be

plants Deferoxamine mesylate injection, 500 mg Iron

hydroxocobalamin) 12 vials

used separately

Digoxin immune Digoxin, digitoxin and 20 vials (most Fab, (Digibind cardiac glycoside require <10 vials) [GlaxoSmithKline; plants Research Triangle Park, NC], DigiFab [Protherics PLC; Cheshire, UK]) Dimercaprol (BAL) Arsenic, mercury, and 6 ampules injection, 100 lead mg/mL, 3 mL DTPA - Calcium (pentetate calcium trisodium), 1 g vial Dirty bomb agents: 1 vial radioactive plutonium, americium, curium Also stocked in Strategic National Stockpile; coordinate with local Homeland Security office Also stocked in Strategic National Stockpile; coordinate with local Homeland Security office

DTPA - Zinc (pentetate zinc trisodium), 1 g vial

Dirty bomb agents: 1 vial radioactive plutonium, americium, curium

Ethanol 10% in 5% Ethylene glycol and dexamethasone, methanol 1,000 mL 4-MP, 1 g/mL, 1.5 mL, Antizol (Jazz Pharmaceuticals; Palo Alto, CA) Ethylene glycol and methanol

3 bottles (or stock fomepizole [4-MP]) 4 ampules (1 tray package) Manufacturer will replace expired stocks

Glucagon injection, -blocker and calcium 10 vials (multidose 1 mg antagonists discontinued) Hydroxocobalamin, Cyanide Cyanokit, 5 g per kit 3 x 5 g kits Can be used instead of cyanide antidote package and with the thiosulfate component

Methylene blue, 10 mg/mL, 10 mL

Methemoglobinemiainducers

5 vials 10 vials Or stock 20 x 0.4 mg/ 2 mL ampules Avoid long-acting agent Sandostatin LAR Depot (Novartis Pharmaceuticals; East Hanover, NJ) Administer slowly and titrate with small doses of 0.5 mg

Naloxone HCL Opiates injection, 1 mg/mL, 10 mL Octreotide injection, 0.1 mg/mL, 1 mL, Sandostatin Sulfonylurea hypoglycemics

2 vials

Physostigmine Anticholinergics salicylate, 1 mg/mL, 2 mL, Antilirium (Forest Pharmaceuticals Inc, St. Louis, MO) Phytonadione (vitamin K1), 10 mg/mL, 1 mL Pralidoxime chloride injection, 50 mg/mL, 20 mL Anticoagulants (coumarin and rodenticides)

10 vials

10 ampules

Organophosphate and 12 vials carbamate pesticides, nerve gases

Also stocked in Strategic National Stockpile; coordinate with local Homeland Security office

Protamine sulfate injection, 10 mg/mL, 5 mL Prussian blue (Radiogardase, 500 mg capsules)

Heparin

4 ampules

Dirty bomb agents: 2 packs of 30 radioactive cesium and capsules thallium, and nonradioactive thallium Isoniazid (INH) 5 g equivalent

Also stocked in Strategic National Stockpile; coordinate with local Homeland Security office 100 mg/mL vials contain the preservative chlorobutanol; need preservativefree preparation

Pyridoxine HCL (vitamin B6)

Succimer Lead, mercury, and (dimercaptosuccinic arsenic acid) 100 mg

20 capsules

* This is not an all-inclusive list. Refer to Olson,39 section III: Therapeutic drugs & antidotes, for suggested stocking levels of additional antidotes. Standard of highest dose to treat a 70 kg patient for 24 h.