ANTIDOTE CHART - California Poison Control System

California Poison Control SystemANTIDOTE CHART(Suggested Stocking Level is based on dose to treat a 70 kg patient for 24 hours)*Updated: 3-11-2008AtropineGeneric/ Name Brand Toxin NotesOrganophosphate/Carbamateinsecticide poisoning andother cholinesteraseinhibitors (eg, warfareagents); bradycardia inducedby a variety of toxinsMay require large amounts insevere cholinesterase inhibitorpoisoning. Also stocked in theStrategic National Stockpile butwill need supplies for first 48hours. Coordinate with localHomeland Security office.Antivenom, Crotalidae Polyvalent® Rattlesnake envenomation 24 vialsImmune-FAB(ovine)/ Cro-FabAntivenom, Black Widow Spider/Antivenom (LatrodectusMactans) ®Black Widow SpiderenvenomationBAL(Dimercaprol)/ BAL in oil10% ® Heavy Metal poisoningCalcium Chloride injectionCalcium channel blockerpoisoning; hypocalcemiainduced by various agentsCan cause tissue necrosis ifextravasation occurs – use largevein for infusion.SuggestedStockingLevel1000 mg total (in vials)Use preservative freeproduct1 x 6000u vial6 x 3 mL (10% in oil)amps20 x 10mL (10%) vialsCalcium Gluconate Powder Hydrofluoric Acid For manufacture of topical gel 1 x 100gm powder bottleHydrofluoric Acid skinexposure or poisoning;Calcium Gluconate injectionhypocalcemia induced byvarious agentsCalcium Gluconate gel/Calgonate Hydrofluoric Acid dermal2.5% gel ® burnsCarnitine (L-Carnitine)/ Carnitor ®Cyanide Antidote Kit/ TaylorCyanide Antidote Kit ®Hyperammonemia fromvalproic acid toxicityCyanide poisoningFor topical burnsThiosulfate component can beused separately. See alsoHydroxocobalamin (Cyanokit®).20 x 10mL (10%) vials6 x 25 gm tubes7 x 1gm vials2 kits (or stock theCyanokit® - seeHydroxocobalamin)Deferoxamine/ Desferal ® Iron poisoning IM administration is discouraged. 12 x 500mg vialsDigoxin Immune FAB (ovine)/Digibind ® or DigiFab®Digoxin poisoning; Othercardiac glycosides (eg,oleander, foxglove)Consult with poison centerregarding dosing, especially forcardiac glycosides than digoxin.15 vials of eitherproductDMSA (Succimer)/ Chemet ® Heavy metal poisoning 1 x 100 capsule bottleDTPA-Calcium(Diethylenetriamine pentaacetate)/Pentetate Calcium Trisodiuminjection)DTPA-Zinc (Diethylenetriaminepentaacetate)/ Pentetate ZincTrisodium injection)Dirty bomb agents:Radioactive plutonium,americium and curiumDirty bomb agents:Radioactive plutonium,americium and curiumAlso stocked in the StrategicNational Stockpile but will needsupplies for first 48 hours.Coordinate with local HomelandSecurity office.Also stocked in the StrategicNational Stockpile but will needsupplies for first 48 hours.Coordinate with local HomelandSecurity office.1 x 1gm vial1 x 1gm vialEDTA-Calcium/ Versenate ® Heavy metal poisoning 18x 1000mg/5mL ampsEthanol IV 10%Ethylene glycol or MethanolpoisoningNote: Ethanol more difficult toobtain, dose and monitor thanfomepizole.Product no longermanufactured

Flumazenil/ Romazicon ®Fomepizole (4-MP)/ Antizol ®GlucagonHydroxycobalamin/ Cyanokit ®Methylene BlueN-Acetylcysteine (NAC)Mucomyst ® or genericN-Acetylcysteine (NAC)Acetadote ®Naloxone/ Narcan ®Benzodiazepine poisoningPreferred antidote forEthylene glycol or MethanolpoisoningBeta blocker/ Calciumchannel blocker poisoningCyanide poisoningMethemoglobinemiaAcetaminophen poisoning(oral preparation)Acetaminophen poisoning(IV preparation)Opioid overdoseUse small initial dose to avoidabrupt awakening/ delirium.Manufacturer will replace expiredstocks.Anticipate nausea and vomiting.Newer cyanide antidote, can beused instead of the conventionalcyanide antidote kit from Taylor.Use orally. Dilute at least by a 3:1ratio.Loading dose should be infusedslowly over 45-60 minutes.Generic N-acetylcysteine can beused if Acetadote® is not available(consult with poison center andgive via micropore filter).Use small initial dose to avoidabrupt awakening/ delirium.Octreotide acetate/ Sandostatin ® Oral sulfonylurea poisoning Avoid long-acting depot products.Physostigmine/ Antilirium ®Pralidoxime(2-PAM)/ Protopam ®Prussian Blue/ Radiogardase ®Pyridoxine (Vitamin B 6 )Vitamin K 1 (Phytonadione)/Mephyton ® or AquaMephyton ®Anticholinergic poisoning,especially antimuscarinicdelirium.Cholinesterase Inhibitorpoisoning (organophosphateor “nerve gas”)Dirty bomb agents:radioactive cesium andthallium and non-radioactivethalliumIsoniazid (INH) poisoningWarfarin, warfarin-basedanticoagulants and superwarfarinbased rodenticidepoisoningAdminister slowly: May causesevere side effects includingbradycardia, asystole and seizuresAlso stocked in the StrategicNational Stockpile but will needsupplies for first 48 hours.Coordinate with local HomelandSecurity office.Also stocked in the StrategicNational Stockpile but will needsupplies for first 48 hours.Coordinate with local HomelandSecurity office.Large amounts needed forpoisoning: 5 grams is theminimum antidotal dose used inan ingestion of an unknownamount. Note: the 100 mg in 1 mlvials contain the preservativechlorobutanol. A 5 gram doserequires 50 vials and will deliver atoxic dose of the preservative.If patient is actively bleeding usefresh frozen plasma or Factor VIIconcentrate.5 x 0.5 mg/5mL vials4 x 1.5mL (1gm/mL)vials10 x 1 mg vials3 x 5gm kits (or stockthe Taylor cyanide kit)5 x 10mL (1%) amps(10mg/mL)7 x 30mL (20%) vials1 carton of 4 x 30mL(20%) vials20 x 0.4mg/2mL amps or10 x 10mg/10mL vials2 x 1mL (0.1mg/mL)amps1 x 5ml 0.2mg/1ml MDV10 x 2mL (1mg/mL) vials12 x 1gm (20mL) vials2 packs of thirty 500 mgcapsules50 x 1mL (100 mg/mL) orthe equivalent (Usepreservative freeproduct.)20 x 5mg tabs10 x 10mg/mL ampsExpert advice regarding use of antidotes is available 24 hours a day, 7 days a weekfrom the California Poison Control System. Call us at1-800-222-1222*Adapted From Olson, KR (Ed): Poisoning & Drug Overdose. 5 th Edition. McGraw-Hill. New York. 2007Note: List is not all-inclusive but reflects agents used more exclusively as antidotesor antidotal agents used infrequently.Updated: 3-11-2008