Antidote Master List
Updated November 6, 2017
There are multiple factors that affect a patient’s presentation and treatment options. The information herein is intended for educational purposes and should not be used to supersede clinical judgement or toxicologic consultation.
| Anti-Venins | Dosage/Administration | Potential Indications | Quantity to Treat One 70 kg Patient for 24 Hours* |
|---|---|---|---|
| Anascorp® - scorpion centruroides species | 3 vials IV | severe envenomation | 3 vials IV |
| Black Widow Spider Antivenin (Lactrodectus mactans) (equine) | 1 vial in 10-50 mL 0.9% sodium chloride IV over 15 minutes OR 1 vial IM in anterolateral thigh | black widow spider envenomation | 1 vial |
| Coral Snake Antivenin (Micrurus fulvius) (equine) | Contact poison control center: 1-800-222-1222 | Eastern or Texas coral snake envenomation | 10 vials |
| Crotalidae Polyvalent Immune F(ab’)2 (equine) (AnaVip®) | Contact poison control center: 1-800-222-1222 | pit viper envenomation | 20 vials |
| Crotalidae Polyvalent Immune Fab (ovine) (CroFab®) | Contact poison control center: 1-800-222-1222 | pit viper envenomation | 20 vials |
| Antidote | Dosage/Administration | Potential Indications | Quantity to Treat One 70 kg Patient for 24 Hours* | |
|---|---|---|---|---|
| N-acetylcysteine | Mucomyst (PO) | Multiple protocols exist. Contact poison control center: 1-800-222-1222 | acetaminophen, cyclopeptide containing mushrooms (e.g. Amanita phalloides), chloroform, carbon tetrachloride, pennyroyal oil | 40 g |
| Acetadote (IV) | Multiple protocols exist. Contact poison control center: 1-800-222-1222 | 40 g | ||
| activated charcoal | Adult: 50 g PO Pediatric: 1 g/kg PO | all oral ingestions besides hydrocarbons, alcohols, metals, corrosives, and foreign objects | 150 g | |
| andexanet alfa (Andexxa) | Per manufacturer recommendation based on last dose of factor Xa inhibitor | Factor Xa inhibitor direct-acting oral anticoagulant | 1800 mg | |
| atropine sulfate | Adult: 1-3 mg IV bolus, repeat 1-5 mg IV Q 2-20 minutes Pediatric: 0.05-0.1 mg/kg/dose IV Q 5-15 minutes | organophosphate, carbamate insecticides, muscarine containing mushrooms | 1 gram | |
| benztropine (Cogentin) | 1-2 mg IV or IM (can repeat up to 4 mg initially) MAINTENANCE: 1-4 mg IV once or twice/daily (max 6 mg/day) | acute dystonic reactions | 6 mg | |
| bromocriptine mesylate (Parlodel) | 2.5-10 mg PO Q 6-8 hours (max 45 mg/day) | neuroleptic malignant syndrome | 45 mg | |
| calcium disodium edetate | 25-75 mg/kg/day IV divided Q 6-12 hours | cadmium, chromium, cobalt, copper, iridium, lead, manganese, mercury, nickel, plutonium, ruthenium, yttrium, zinc, zirconium | 5 g | |
| calcium gluconate 10% | Contact poison control center: 1-800-222-1222 | calcium channel blockers, hydrofluoric acid | 10-20 g | |
| Cyanide Antidote Kit (Nithiodote) (also see hydroxocobalamin) | sodium nitrite | Contact poison control center: 1-800-222-1222 | cyanide and hydrogen sulfide toxicity | 2 kits |
| sodium thiosulfate | ||||
| cyproheptadine (Periactin) | Adult: 12 mg PO or NG initially then 8 mg Q 6 hours (32 mg max/day) Pediatric: 0.25 mg/kg/day in 4 divided doses | serotonin syndrome | 32 mg | |
| dantrolene sodium (Dantrium)(Ryanodex) | 1-2.5 mg/kg IV (repeat until symptoms subside)(max 10 mg/kg) | neuroleptic malignant syndrome | Dantrium (20 mg/vial): 35 vials Ryanodex (250mg/vial): 3 vials | |
| deferoxamine mesylate (Desferal) | 15-40 mg/kg/hour IV | iron, aluminum, manganese, neptunium, plutonium | 67 g | |
| digoxin immune Fab (ovine) (Digifab) | Adult and Pediatric: -Empiric dosing: 20 vials | digoxin, cardiac glycosides (oleander, foxglove, red squill, bufo toad) | 20 vials | |
| If serum level available: [serum digoxin] x weight (kg)/100 kg = # of vials If ingested amount known each vial is expected to bind 500 mcg of ingested digoxin | ||||
| dimercaptosuccinic acid (DMSA) (succimer, Chemet) | 10 mg/kg PO TID for 5 days then 10 mg/kg PO BID for 14 days | lead | 2000 mg | |
| dimercaprol (BAL) | 3-5 mg/kg IM Q 4-6 hours (contraindication peanut allergy) | lead, mercury, arsenic, gold, antimony, bismuth, lead, nickel, polonium | 2100 mg | |
| ethyl alcohol 95% (ethanol) | Contact poison control center: 1-800-222-1222 | methanol, ethylene glycol | 250 mL of 95% ethanol | |
| flumazenil (Romazicon) | Contact poison control center: 1-800-222-1222 | benzodiazepines, zolpidem, eszopiclone | 5 mg | |
| folic acid | 50 mg IV Q 4 hours | methanol | 300 mg | |
| fomepizole (Antizol) | LOAD: 15 mg/kg IV over 30 minutes MAINTENANCE: 10 mg/kg IV Q 12 hours for 4 doses then 15 mg/kg IV Q 12 hours thereafter | methanol, ethylene glycol | 3000 mg | |
| glucagon (Glucagen) | Adult: LOAD: 5-10 mg IV MAINTENANCE: 2.5-5 mg/hour IV | beta blockers, calcium channel blockers | 100 mg | |
| Pediatric: LOAD: 50-150 mcg/kg IV MAINTENANCE: 50-150 mcg/kg/hour IV | ||||
| glucarpidase (Voraxaze) | 50 units/kg IV | methotrexate | 3500 units | |
| hydroxocobalamin (Cyanokit) | 5 g IV (can repeat) | cyanide, hydrogen sulfide | 20 g | |
| idarucizumab (Praxbind) | 5 g IV given as two consecutive 2.5 g IV boluses | dabigatran | 10 g | |
| insulin (regular) | LOAD: 1 unit/kg IV bolus | calcium channel blocker, beta blocker | 20,000 units | |
| INFUSION: 1-10 unit/kg/hour continuous IV infusion | ||||
| lipid emulsion 20% (Intralipid) | Contact poison control center: 1-800-222-1222 | severe intoxication with lipophilic drug (cyclic antidepressants, bupropion, calcium channel blockers, beta blockers) | 1000 mL | |
| Contact poison control center: 1-800-222-1222 | local anesthetic systemic toxicity | |||
| leucovorin (folinic acid) | 50 mg IV once | methanol | 50 mg | |
| levocarnitine (Carnitor) | LOAD: 100 mg/kg IV (max 6000 mg given over 30 minutes) MAINTENANCE: 15 mg/kg (max 3000 mg) IV Q 4 hours | valproic acid-induced hyperammonemic encephalopathy | 12 g | |
| mannitol 20% | 1 g/kg IV over 30 minutes | ciguatera | 70 g | |
| methylene blue | 1-2 mg/kg IV over 5 minutes, may repeat in 30-60 minutes (max 7 mg/kg/day) | methemoglobinemia | 500 mg | |
| naloxone | naloxone intravenous | 0.4-10 mg IV Q 15-45 minutes or by continuous infusion | opioids, clonidine, tizanidine | 30 mg |
| Narcan nasal atomizer | 2-4 mg IN, alternate nostrils Q 1-5 minutes | |||
| Evzio intramuscular | 0.4-2 mg IM repeated every 2-3 minutes as needed | |||
| octreotide (Sandostatin) | Adult: 50 mcg IV or SQ every 6-12 h | sulfonylureas | 200 mcg | |
| Pediatric: 1-1.25 mcg/kg SQ up to 50 mcg/dose (or if given IV, diluted in 50 mL D5W or NS and given over 15-30 minutes) | ||||
| D-penicillamine (Cuprimine) | Contact poison control center: 1-800-222-1222 | lead, mercury, arsenic, copper, antimony, bismuth, gallium, gold, palladium, polonium | 1500 mg | |
| Contact poison control center: 1-800-222-1222 | ||||
| pentetate calcium trisodium (calcium-DTPA) | 1000 mg IV or inhaled | internal contamination with plutonium, americium, or curium | 1000 mg | |
| pentetate zinc trisodium (zinc-DTPA) | 1000 mg IV or inhaled | internal contamination with plutonium, americium, or curium | 1000 mg | |
| physostigmine (Antilirium) | Adult: 1-2 mg slow IV push | anticholinergic toxicity | 30 mg | |
| Pediatric: 0.02 mg/kg slow IV push | ||||
| polyethylene glycol electrolyte lavage solution (Golytely, Colyte) | Adult: 500 mL/hour titrated up by 500 mL/hour Q 30 minutes to a goal rate of 2 L/hour PO or NG | whole bowel irrigation | 12 L | |
| Pediatric: Initiate NG infusion at 5-10 mL/kg/hour and titrate up to 25 mL/kg/hour | ||||
| potassium iodide | Adult: 130 mg PO | iodine 131 | 130 mg | |
| Pediatric (3 years - 18 years): 65 mg PO | 130 mg | |||
| Pediatric (1 month - 3 years): 32 mg PO | ||||
| Pediatric (birth - 1 month): 16 mg PO | ||||
| pralidoxime (2-PAM, Protopam) | Adult: LOAD: 30 mg/kg (max 2 g) IV over 30 minutes MAINTENANCE: 8-10 mg/kg/hour (max 500 mg/hour) | organophosphates | 12 g | |
| Pediatric: LOAD: 20-40 mg/kg (max 2 g) IV over 30 minutes MAINTENANCE: 10-20 mg/kg/hr (max 500 mg/hour) | ||||
| protamine sulfate | 1-1.5 mg to reverse each 100 units of heparin | heparin | 250 mg | |
| prothrombin complex concentrate, human (PCC) (Kcentra, FEIBA, etc.) | Contact poison control center: 1-800-222-1222 | To reverse life-threatening bleeding associated with exposure to warfarins, brodifacoum, hydroxycoumarins, other anticoagulants (apixaban, dabigatran, rivaroxaban, edoxaban, etc.) | 5000 units of Kcentra; 2 vials of FEIBA | |
| prussian blue (Radiogardase) | Adult: 3 g PO TID | thallium and cesium 137 | 9 g | |
| Pediatric: 1 g PO TID | NOTE: patients normally require at least 30 days of treatment | |||
| pyridoxine (vitamin B6) | 1 g for every 1 g isoniazid ingested OR 70 mg/kg IV (max 5000 mg) | isoniazid, hydrazines, Gyromitra mushrooms | 5 g | |
| thiamine | 100 mg IV daily (ethylene glycol toxicity); 500 mg IV Q8H (Wernicke-Korsakoff syndrome) | Wernicke-Korsakoff Syndrome, ethylene glycol | 1500 mg | |
| uridine triacetate (Vistogard) | 10 g (1 packet) PO Q 6 hours for 20 doses | 5-fluorouracil or capecitabine | 40 g | |
| vitamin K (Aqua Mephyton, phytonadione) | INR >= 10 with no bleeding: 2.5-5 mg PO (Note: may be significantly higher for long-acting vitamin K antagonists) | warfarins, brodifacoum, hydroxycoumarins | 100 mg IV, 100 mg PO | |
| Serious bleeding regardless of INR: 5-10 mg/dose IV slow infusion | ||||
*This quantity is not intended to represent a recommended par level nor is it a required amount to have on hand at all facilities.