NOTES ON DRUG POISONING AND ANTIDOTE @2018PPASagar [Copyright protected]

LIST OF ANTIDOTES FOR DRUG POISONING

Antidotes to Common Medications
No. Drugs Antidote
01 Acetaminophen N-Acetylcysteine or Mucomyst
02 Anticholinesterase Atropine or Pralidoxime
03 Anticholinergics, diphenhydramine, Physostigmine
dimenhydrinate
04 Antifreeze Fomepizole, Ethanol
05 BenzodiazepinesZaleplonZolpidem Flumazenil (Romazicon)
06 Beta-Blocking agents, Calcium channel Glucagon, Epinephrine
blockers, Hypoglycemia, Hypoglycemic
agents
07 Calcium Channel Blockers Calcium Chloride, Glucagon
08 Coumadin Phytonadione or Vitamin K
09 Cyanide Amyl nitrite, sodium nitrite, sodium
thiosulfate
10 Cyclophosphamide Mesna
11 Digoxin Digibind or Digoxin Immune Fab
13 Heroin Naloxone (Narcan) or Nalmefene
14 Iron Deferoxamine
15 Heparin Protamine Sulfate
16 Lead EDTA, dimercaprol, succimer
18 Methotrexate Leucovorin calcium
19 Potassium Insulin + Glucose, Kayexalate
20 Methanol Folic acid
21 Valproic acid L-Carnitine
22 Sulfonylureas Octreotide (Sandostatin )
23 Isoniazid, ethylene glycol Pyridoxine HCl (Vitamin B6)
24 Sodium channel blockers (e.g. cyclic Sodium Bicarbonate
antidepressants), salicylates
25 Ethylene glycol Thiamine
26 Calcium channel blockersFluoride salts (e.g., Calcium chloride andCalcium gluconate
NaF)Hydrofluoric acid (HF)Hyperkalemia
(not digoxin-induced)Hypermagnesemia
27 Ethylene glycolMethanol Ethanol
28 Alpha agonists (e.g., clonidine), Opioids (e.g., Naloxone
codeine, diphenoxylate, fentanyl, heroin,
meperidine, morphine and propoxyphene)
29 Arsenic, Copper, Lead, Mercury D-Penicillamine (Cuprimine )
30 Local anesthetics and possibly othercardiac Fat emulsion (Intralipid , Liposyn II , Liposyn
toxins (e.g., bupropion, calciumchannel III )
blockers, cocaine, beta blockers, tricyclic
antidepressants)
How The Poison Enter Into The Body?
 The Poison In Any Form may be taken in by the breath Or swallowed, Absorbed
 Through the thinner and more delicate mucous membranes, Or absorbed through the skin,
or implanted by stings, bites, or other wounds.
 There Are A lot Of Antidotes In The Medical Field Today But Some Antidotes Are Very
Important And Need To Be Remembered Because Of Their Frequent Use In The Emergency
Situations. Knowledge About Antidotes
 Is Very Important For All Medical Professionals Especially Those Who Are Working In
Health Care Settings.Here Are Some Of The Types And List Of Very Important And
Frequently Used Antidotes ;

Pioneer Pharma AcademySagar (M.P.)(1) 7000409969, 6264805074

 NOTES ON DRUG POISONING AND ANTIDOTE @2018PPASagar [Copyright protected]

Types of Antidotes
1: Universal Antidotes :This type of antidote is Given when unknown poison is ingested
Composition:
(1):powdered charcoal 2 parts
(2):Magnesium oxide 1 part
(3):Tannic Acid 1 Part
2: Chemical Antidotes :These substances neutrilize the chemical action or oxidize the poison
into nontoxic or insolouble form
eg:
 Dilute alkali(milk of magnesia)
 Dilute acetic acid,
 Potassium permangante
 Tannin(strong tea).
3: Physiological or pharmacological Antidotes
These produce effects opposite to that of poison
eg:
 Naloxone for morphine,
 Atropine and oxime for organophosphorous poison,
 N-acetylcysteine for acetaminophen
4: Mechanical or physical Antidotes :
These substances prevents the absorption of poison by their presence
eg: Activated charcoal is used for strychinine.
 Emulcents(fats,oils,milk,eggalbumin) are used for corrosive and irritant poisoning,
 Bulky food used for glass poisoning And mineral poisoning(dose 30-60 gms for children and 60-
100gms for adults)
5: Chelating agents:
These are substances which form chelates(non ionized complexes) with cations.These are
mostly used in heavy metal poisoning
eg:
 N-pencillamine for mercury,lead,copper
 BAL(dimercepol) is used in heavy metal poisons
 EDTA is used in Arsenic,mercury,lead
 Versenate is used in Arsenic,mercury and lead
 Desferoxamine is used for iron.
Important Antidotes List
Antidotes For
 Non-specific poisons except cyanide, iron, lithium, caustics and alcohol = Activated charcoal
 Cobra bite = Snake Anti-Venin.
 Heparin = Protamine Sulfate
 Gas=Use artificial respiration,Remove patient to air, apply heat to extremities; send for doctor.
 Absinthe = Give an active emetic; then flaxseed tea freely; stimulate
 Insulin reaction = Glucose (Dextrose 50%)
 Alkali, Volatile = Drink freely of water with vinegar or lemon juice in it.
 Antimonial Wine = Give warm water freely to encourage vomiting.
 Aqua Fortis = Magnesia or soap dissolved in water, every two minutes.
 Bed Bug Poison = Give milk or white of eggs in large quantities.
 Belladona = Active emetic; stimulate.
 Acetaminophen/Paracetamol = N-Acetylcysteine or Mucomyst
 Anticholinergics, diphenhydramine, dimenhydrinate =Physostigmine
 BenzodiazepinesZaleplonZolpidem = Flumazenil (Romazicon)
 Calcium Channel Blockers = Calcium Chloride, Glucagon
 Cyanide = Amyl nitrite, sodium nitrite, sodium thiosulfate
 Iron = Deferoxamine
 For Chemicals causing methemoglobinemia in patients with G6PD deficiency = Vitamin C

Pioneer Pharma AcademySagar (M.P.)(2) 7000409969, 6264805074

 NOTES ON DRUG POISONING AND ANTIDOTE @2018PPASagar [Copyright protected]

 For Lead = EDTA, dimercaprol, succimer

 Methanol = Folic acid
 Ammonia = Lemon juice, diluted vinegar or acetic acid.
 Methotrexate = Leucovorin calcium
 Potassium = Insulin + Glucose, Kayexalate
 Mercury = White of eggs freely; afterwards evacuate; mild drinks
 Valproic acid = L-Carnitine
 Isoniazid, ethylene glycol = Pyridoxine HCl (Vitamin B6)
 Tricyclic antidepressants = phyostigmine or NaHCO3
 Sulfonylureas = Octreotide (Sandostatin )
 Alpha agonists (e.g., clonidine), Opioids (e.g., codeine, diphenoxylate, fentanyl, heroin,
meperidine, morphine and propoxyphene = Naloxone
 Arsenic, Copper, Lead, Mercury = D-Penicillamine (Cuprimine )
 Neuromuscular blockade = anticholinesterase agents.
 Anticholinesterase = atropine sulfate or pralidoxime.
 Fluoride ingestion = Calcium salts
 Digoxin = digibind digoxine immune fab
 Beta blockers and calciumchannel blockers = glucagon
 Ergotamine = Heparin
 Dopamine = Phentolamine.
SUMMERY OF DRUG AND ANTIDOTE
Antidote Indication(POISONING) Mode of Action
acetylcysteine (Mucomyst) Acetaminophen/ Tylenol/ Restores depleted
Paracetamol glutathione stores and
protects against renal and
hepatic failure.
Activated charcoal Non-specific poisons except Absorption of drug in the
cyanide, iron, lithium, caustics gastric and intestinal tracts.
and alcohol. Interrupts the entero-hepatic
cycle with multiple dose.
albuterol inhaler, insulin & Potassium
glucose, NaHCO3, kayexalate
anticholinesterase agents Neuromuscular blockade
(paralytics)
atropine sulfate or Anticholinesterase Competitive inhibition of
pralidoxime muscarinic receptors.
Benzylpenicillin Amanita phalloides (Death cap Not known; partial
mushroom) protection against acute
hepatic failure; may displace
amatoxin from protein-
binding sites allowing
increased renal excretion;
may also inhibit penetration
of amatoxin to hepatocytes.
Calcium salts Fluoride ingestion Rapidly complexes with
fluoride ion.
deferoxamine Iron Deferoxamine acts by
binding free iron in the
bloodstream and enhancing
its elimination in the urine.
digibind Digoxin Binds molecules of digoxin,
digoxine immune fab making them unavailable for
binding at their site of action
on cells in the body.

Pioneer Pharma AcademySagar (M.P.)(3) 7000409969, 6264805074

NOTES ON DRUG POISONING AND ANTIDOTE @2018PPASagar [Copyright protected]

dimercapol, edetate calcium, Lead Chelation of lead ions and

disodium, endogenous metals (e.g.,
zinc, manganese, iron,
copper).
diphenhydramine (Benadryl) Extrapyramidal symptoms A potent antagonist to
(EPS) acetylcholine in muscarinic
receptors.
flumazenil Benzodiazepines Reverses the effects of
benzodiazepines by
competitive inhibition at the
benzodiazepine binding site
on the GABAA receptor.
fomepizole Ethylene glycol 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.
glucagon Beta blockers and calcium Stimulates the formation of
channel blockers adenyl cyclase causing
intracellular increase in
cycling AMP and enhanced
glycogenolysis and elevated
serum glucose
concentration.
Glucose (Dextrose 50%) Insulin reaction 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.
Heparin Ergotamine Reverses hypercoagulable
state by interacting with
antithrombin III. Used in
combination with
vasodilator phentolamine or
nitroprusside to prevent
local thrombosis and
ischemia.
Hydroxocobalamin Cyanide Forms cyanocobalamin, a
non-toxic metabolite that is
easily excreted through the
kidneys.
leucovorin calcium Fluorouracil
Methotrexate Protects the healthy cells
from the effects of
methotrexate while allowing
methotrexate to enter and
kill cancer cells.
Magnesium sulfate calcium gluconate
mesna Cyclophosphamide A “chemoprotectant” drug
that reduces the undesired

Pioneer Pharma AcademySagar (M.P.)(4) 7000409969, 6264805074

NOTES ON DRUG POISONING AND ANTIDOTE @2018PPASagar [Copyright protected]

effects of certain
chemotherapy drugs.
Methylene blue Chemical producing severe Reduces methemoglobin to
methemoglobinemia. Ifosamide- hemoglobin.
induced encephalopathy.
nalmefene or naloxone Opioid analgesics Prevents or reverses the
effects of opioids including
respiratory depression,
sedation and hypotension.
naloxone (Narcan) Narcotics 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.
Neostigmine Anticholinergics Anticholinesterase which
causes accumulation of
acetylcholine at cholinergic
receptor sites.
Nitrite, sodium and Cyanide Oxidizes hemoglobin to
glycerytrinitrate methemoglobin which binds
the free cyanide and can
enhance endothelial cyanide
detoxification by producing
vasodilation.
Penicillamine Copper, gold, lead, mercury, Chelation of metal ions.
zinc, arsenic
phentolamine (Regitine) Dopamine 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.
phyostigmine or NaHCO3 Tricyclic antidepressants A reversible
anticholinesterase which
effectively increases the
concentration of
acetylcholine at the sites of
cholinergic transmission.
Phytomenadione (Vitamin Coumadin/Warfarin Bypasses inhibition of
K.) Vitamin K epoxide reductase
enzyme.
protamine sulfate Heparin Protamine that is strongly
basic combines with acidic
heparin forming a stable
complex and neutralizes the
anticoagulant activity of both
drugs.
Pyridoxine Isoniazid, theophylline, Reverses acute pyridoxine
monomethyl hydrazine. deficiency by promoting
Adjunctive therapy in ethylene GABA synthesis. Promotes

Pioneer Pharma AcademySagar (M.P.)(5) 7000409969, 6264805074

NOTES ON DRUG POISONING AND ANTIDOTE @2018PPASagar [Copyright protected]

glycol poisoning. the conversion of toxic

metabolite glycolic acid to
glycine.
Snake anti-venin Cobra bite Neutralizes venom by
binding with circulating
venom components and with
locally deposited venom by
accumulating at the bite site.
Sodium Bicarbonate Iron Prevents convertion of
ferrous to ferric.
Cardiotoxic drug affecting fast Decreases affinity of
sodium channel (TCA, cocaine) cardiotoxic drugs to the fast
sodium channel.
Weak acids Promotes ionization of weak
acids.
Chlorine gas inhalational Neutralization of
poisoning hydrochloric acid formed
when chlorine gas reacts
with water in the airways.
Sodium thiosulphate Cyanide 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.
Thiamine Alcohol, Wernicke-Korsakoff Reverses acute thiamine
Syndrome deficiency
Adjunctive in ethylene glycol Enhances detoxification of
glyoxylic acid.
Vitamin C Chemicals causing Reduces methemoglobin to
methemoglobinemia in patients hemoglobin.
with G6PD deficiency

Pioneer Pharma AcademySagar (M.P.)(6) 7000409969, 6264805074