Give an antidote (if available) when there is reasonable certainty of a specific diagnosis (Table 38–3). Be aware that some antidotes themselves may have serious side effects. The indications and dosages for specific antidotes are discussed in the respective sections for specific toxins.
Table 38–3.Some toxic agents for which there are specific antidotes.1 |Favorite Table|Download (.pdf) Table 38–3. Some toxic agents for which there are specific antidotes.1
|Toxic Agent ||Specific Antidote |
|Acetaminophen ||N-Acetylcysteine |
|Anticholinergics (eg, atropine) ||Physostigmine |
|Anticholinesterases (eg, organophosphate pesticides) ||Atropine and pralidoxime (2-PAM) |
|Benzodiazepines ||Flumazenil (rarely used)2 |
|Carbon monoxide ||Oxygen (hyperbaric oxygen of uncertain benefit) |
|Cyanide ||Sodium nitrite, sodium thiosulfate; hydroxocobalamin |
|Digitalis glycosides ||Digoxin-specific Fab antibodies |
|Heavy metals (eg, lead, mercury, iron) and arsenic ||Specific chelating agents |
|Isoniazid ||Pyridoxine (vitamin B6) |
|Methanol, ethylene glycol ||Ethanol (ethyl alcohol) or fomepizole (4-methylpyrazole) |
|Opioids ||Naloxone, nalmefene |
|Snake venom ||Specific antivenin |
|Sulfonylurea oral hypoglycemic drugs ||Glucose, octreotide |
et al. Expert consensus guidelines for stocking of antidotes in hospitals that provide emergency care. Ann Emerg Med. 2018 Mar;71(3):314–25.
et al. Direct oral anticoagulant reversal: how, when and issues faced. Expert Rev Hematol. 2017 Nov;10(11):1005–22.
et al. Calcium channel antagonist and beta-blocker overdose: antidotes and adjunct therapies. Br J Clin Pharmacol. 2016 Mar;81(3):453–61.
et al. Organophosphate-hydrolyzing enzymes as first-line of defence against nerve agent-poisoning: perspectives and the road ahead. Protein J. 2016 Dec;35(6):424–39.
et al. Drug shortages: implications for medical toxicology. Clin Toxicol (Phila). 2015 Jul;53(6):519–24.
et al. Antidotes for poisoning by alcohols that form toxic metabolites. Br J Clin Pharmacol. 2016 Mar;81(3):505–15.
M. Chemical warfare agents. Classes and targets. Toxicol Lett. 2018 Sep 1;293:253–63.