ANTIDOTES AND THE CLINICAL APPLICATIONS

Antidote:*An Antidote is a substance which can counteract a form of

poisoning.Mechanism of Action:*Antidotes work in any one of a number of ways.
Common modes of action are as follows:*1. Inert complex formation:*Some antidotes
interact with the poison to form an inert complex which is then excreted from the
body.*e.g. chelating agents for heavy metals, Prussian Blue for thallium, specific
antibody fragments for digoxin, *2. Accelerated detoxification: Some antidotes
accelerate the detoxification of a poison.*e.g. thiosulfate accelerates the conversion of
cyanide to nontoxic thiocyanate, * 3. Reduced toxic conversion:The best example of this
mode of action is provided by ethanol which inhibits the metabolism of methanol to toxic
metabolites by competing for the same enzyme 4.Receptor site competition:Some
antidotes displace the poison from specific receptor sites, thereby antagonising the effects
completely.Eg: naloxone, which antagonises the effects of opiates at stereo-specific
opioid receptor sites.5. Receptor site blockade:This mode of action s best exemplified
by atropine which blocks the effects of anticholinesterase agents such as
organophosphates at muscarinic receptor sites.6. Toxic effect bypass:An example of this
type of antidotal action is provided by the use of 100% oxygen in cyanide poisoning.The
table below represents a list of genuine antidotes recommended in toxicological practice
today. Specific Antidotes:

poision antidode
acetominophen Acetyl cystine
aniline Methylene blue
anticholinesterase Atropine
B blockers Atropine ,insuline ,ca+
Ca+ channel blockers Atropine ,insuline ,ca+
digioxin atropine
isoniazid pyridoxine
opioids nalaxone

In addition, there are certain therapeutic agents which are not antidotes as per the
accepted definition, but which through their importance and sometimes specific role in
the treatment of poisons,. These are called as Adjunctival or Adjuvant Antidotes
Adjuvant Antidotes:

agent indication
benztropine dystonia
diazepam convulsion
dopamine Vascular relaxation
epinephrine Cardiac arrest
glucose hypoglycemia

Obsolete Antidotes:
Obsolute poisioning Indication poisioning
Copper sulfate Phosphorus
cysteamine paracetmol
nalorphine opiates
tocopherol Paraqual
Unfortunately in India and other developing countries, cumbersome governmental
regulations and a lack of economic incentives for manufacturers have restricted
availability of a substantial number of these life-saving drugs.The following table
represents few examples of obsolete antidotes

Role of Antidotes in Poisoning:*Antidotes may play. important role in the treatment of

poisoning.*While good supportive care and elimination techniques restore a poisoned
patient to good *In certain circumstances, they may significantly reduce the medical
resources otherwise *Thus antidotes may sometimes reduce the overall burden on the
health service of managing poisioning.*In areas remote from good hospital services, and
in particularly in developing countries that lack adequate facilities for supportive care,
antidotes may be even more essential in the treatment of poisoning. Universal
Antidote:A mixture of 50% activated charcoal, 25% magnesium oxide and 25% tannic
acid is called as universal antidote.*It is formerly thought to be useful for most types of
acid, heavy metal, alkaloid and glycoside poisonings water.