ANTIDOTE CHART - California Poison Control System

Sodium Nitrite CyanideSodium ThiosulfateCyanokit®/HydroxycobalaminCyanide;Sodium nitroprusside toxicityCyanide poisoningDeferoxamine/ Desferal Iron poisoning IV use onlyDigoxin Immune FAB(ovine)/ Digibind orDigiFab®DMSA (Succimer)/ Chemet DTPA-Calcium(Diethylenetriaminepentaacetate)/ PentetateCalcium Trisodiuminjection)DTPA-Zinc(Diethylenetriaminepentaacetate)/ PentetateZinc Trisodium injection)EDTA-Calcium/ Versenate Ethanol IV 10% with 5%DextroseEthanol (oral) / VodkaFlumazenil/ Romazicon Fomepizole (4-MP)/ Antizol GlucagonMethylene BlueDigoxin poisoning; othercardiac glycosides (eg,oleander, foxglove)Heavy metal poisoningDirty bomb agents:radioactive plutonium,americium and curiumDirty bomb agents:radioactive plutonium,americium and curiumHeavy metal poisoningEthylene glycol or methanolpoisoningEthylene glycol or methanolpoisoningBenzodiazepine poisoningPreferred antidote forethylene glycol or methanolpoisoningBeta blocker/calciumchannel blocker poisoningMethemoglobinemiaRisk of methemoglobinemiawith useNewer, safer and easier to usethan the conventional cyanideantidote kit.Consult with poison centerregarding dosing, especiallyfor cardiac glycosides thandigoxin.Stocked in the StrategicNational Stockpile but willneed supplies for first 48hours. Coordinate with localHomeland Security office.Stocked in the StrategicNational Stockpile but willneed supplies for first 48hours. Coordinate with localHomeland Security office.Note: IV 10% ethanol productno longer manufactured.Fomepizole easier to dose andmonitor than ethanol.Fomepizole easier to dose andmonitor than ethanol. Oralethanol can be used in anemergency situation.Use small initial dose to avoidabrupt awakening/ delirium. Donot use in patients on chronicbenzodiazepine therapy aswithdrawal seizures mayoccur. Also use with caution inmixed drug overdoses.Manufacturer will replaceexpired stocks.Anticipate nausea andvomiting.30 x 10 mL (3%) amps(Less expensive: Stockinstead of the AkornCyanide antidote kit)30 x 50 mL (25%) vials(Less expensive: Stockinstead of the AkornCyanide antidote kit)8 hours: 10 g or 2 kits24 hours:10 g or 2 kits(OR stock the Akorncyanide antidote kit or theindividual kit components)8 hours: 12 gms or 6 x 2gm vials24 hours: 36 gms or 18 x 2gm vials8 hours: 15 vials of eitherproduct24 hours: 20 vials of eitherproduct8 hours: 1 gm or 10 x 100mg capsules24 hours: 3 gms or 30 x100 mg capsules8 hours: 1 x 1 gm amp24 hours: 1 x 1 gm amp8 hours: 1 x 1 gm amp24 hours: 1 x 1 gm amp8 hours: 1 gm or 1 1000mg/5mL amp24 hours: 3 gms or 3 1000mg/5mL amps8 hours: 2 x 1 liter24 hours: 4 x 1 liter(Can be prepared using95% ethanol product)8 hours: one pint24 hours: 750mL8 hours: 6 mg or 6 x1mg/10 mL vials24 hours: 12 mg or 12 x 1mg/10 mL vials8 hours: 1.5 g or 1 x 1.5mL(1g/mL) vials24 hours: 6.0 g or 4 x 1.5mL (1g/mL) vials8 hours: 90 mg or 90 x 1mg kits24 hours: 250 mg or 250 x1 mg kits8 hours: 400 mg or 4 x 10mL (10 mg/mL) amps24 hours: 600 mg or 6 x 10mL (10 mg/mL) amps

N-Acetylcysteine (NAC)Mucomyst or genericN-Acetylcysteine (NAC)Acetadote ®Naloxone/ Narcan Octreotide acetate/Sandostatin Physostigmine/ Antilirium ®Pralidoxime(2-PAM)/Protopam Prussian Blue/Radiogardase ®Pyridoxine (Vitamin B 6 )Vitamin K 1 (Phytonadione)/Mephyton orAquaMephyton Acetaminophen poisoning(oral preparation)Acetaminophen poisoning(IV preparation)Opioid overdoseOral sulfonylurea poisoningAnticholinergic poisoning,especially antimuscarinicdelirium.Cholinesterase Inhibitorpoisoning (organophosphateor “nerve gas”)Dirty bomb agents:radioactive cesium andthallium and non-radioactivethalliumIsoniazid (INH) poisoningWarfarin, warfarin-basedanticoagulants and superwarfarinbased rodenticidepoisoningUse orally. Dilute at least by a3:1 ratio.Loading dose should beinfused slowly over 45-60minutes. Generic N-acetylcysteine can be used ifAcetadote® is not available(consult with poison center andadminister via a microporefilter).Use small initial dose to avoidabrupt awakening/withdrawal.Avoid long-acting depotproducts.Administer at low dose (0.5mg) and slowly, over 2-5minutes to avoid severeadverse reactions includingbradycardia, asystole andseizures. (Contraindicated inTCA or similar poisoning withwidened QRS intervals.)Also stocked in the StrategicNational Stockpile but willneed supplies for first 48hours. Coordinate with localHomeland Security office.Stocked in the StrategicNational Stockpile but willneed supplies for first 48hours. Coordinate with localHomeland Security office.Large amounts needed forpoisoning: 5 grams is theminimum antidotal dose usedin an ingestion of an unknownamount. Note: the 100 mg in 1mL vials contain thepreservative chlorobutanol. A 5gram dose requires 50 ofthese vials and will deliver atoxic dose of the preservative.If patient is actively bleedinguse fresh frozen plasma orFactor VII concentrate.8 hours: 28 g or 5 x 30mL(20%) vials24 hours: 56 g or 10 x 30mL (20%) vials8 hours: 24 g or 4 x 30 mL(20%) vials24 hours: 30 g or 5 x 30mL (20%) vials8 hours: 20 mg or 50 x 0.4mg/2mL amps or 2 x 10mg/10mL vials24 hours: 40 mg or 4 x 10mg/mL vials8 hours: 200 mcg or 2 x1mL (0.1mg/mL) amps24 hours: 1000 mcg or 1 x5mL (0.2mg/mL) MultidoseVial8 hours: 4 mg or 2 x 2mL(1mg/mL) amps24 hours: 20 mg or 10 x 2mL (1 mg/mL) amps8 hours: 7 g or 7 x 1 gm(20 mL) vials24 hours: 18 g or 18 x 1gm (20 mL) vialsMinimum order is 25 bottles(30 capsules each)8 hours: 9 g or 3 vials (100mg/mL, 30 mL each) or theequivalent (Usepreservative free product.)24 hours: 24 g or 8 vials(100 mg/mL, 30 mL each)or the equivalent8 hours: 50 mg or 10 x 5mg tabs or 5 x 10 mg/mLamps24 hours: 200 mg or 40 x 5mg tabs or 20 x 10 mg/mLampsExpert advice regarding use of antidotes and treatment of poisoning and overdose isavailable 24 hours a day, 7 days a week from the California Poison Control System.Health Professionals, call 1-800-411-8080Members of the public, call 1-800-222-1222*Adapted from Dart RC et al. Annals of Emergency Medicine. 2009; 54(3):386-394.Note: List is not all-inclusive but reflects agents used more exclusively as antidotesor antidotal agents used infrequently.Updated: 3-6-2012