An antidote is a substance that can counteract a form of poisoning. The term antidote is a Greek word meaning “given against”. This post will help you familiarize with the common antidotes that are used in the hospital setting. The following are antidotes that should be familiarized by the nurse to respond to this emergency situation quickly.

Table of Antidotes

Antidote Indication Mode of Action
acetylcysteine (Mucomyst) Acetaminophen/ Tylenol/ Paracetamol Restores depleted glutathione stores and protects against renal and hepatic failure.
Activated charcoal Non-specific poisons except cyanide, iron, lithium, caustics and alcohol. Absorption of drug in the gastric and intestinal tracts. Interrupts the entero-hepatic cycle with multiple dose.
albuterol inhaler, insulin & glucose, NaHCO3, kayexalate Potassium
anticholinesterase agents Neuromuscular blockade (paralytics)
atropine sulfate or pralidoxime Anticholinesterase Competitive inhibition of muscarinic receptors.
Benzylpenicillin Amanita phalloides (Death cap mushroom) Not known; partial protection against acute hepatic failure; may displace amatoxin from protein-binding sites allowing increased renal excretion; may also inhibit penetration of amatoxin to hepatocytes.
Calcium salts Fluoride ingestion Rapidly complexes with fluoride ion.
deferoxamine Iron Deferoxamine acts by binding free iron in the bloodstream and enhancing its elimination in the urine.
digoxine immune fab
Digoxin Binds molecules of digoxin, making them unavailable for binding at their site of action on cells in the body.
dimercapol, edetate calcium, disodium, Lead Chelation of lead ions and endogenous metals (e.g., zinc, manganese, iron, copper).
diphenhydramine (Benadryl) Extrapyramidal symptoms (EPS) A potent antagonist to acetylcholine in muscarinic receptors.
flumazenil Benzodiazepines Reverses the effects of benzodiazepines by competitive inhibition at the benzodiazepine binding site on the GABAA receptor.
fomepizole Ethylene glycol A competitive inhibitor of the enzyme alcohol dehydrogenase found in the liver. This enzyme plays a key role in the metabolism of ethylene glycol and methanol.
glucagon Beta blockers and calcium channel blockers Stimulates the formation of adenyl cyclase causing intracellular increase in cycling AMP and enhanced glycogenolysis and elevated serum glucose concentration.
Glucose (Dextrose 50%) Insulin reaction Dextrose (the monosaccharide glucose) is used, distributed and stored by body tissues and is metabolized to carbon dioxide and water with the release of energy.
Heparin Ergotamine Reverses hypercoagulable state by interacting with antithrombin III. Used in combination with vasodilator phentolamine or nitroprusside to prevent local thrombosis and ischemia.
Hydroxocobalamin Cyanide Forms cyanocobalamin, a non-toxic metabolite that is easily excreted through the kidneys.
leucovorin calcium Fluorouracil
Methotrexate Protects the healthy cells from the effects of methotrexate while allowing methotrexate to enter and kill cancer cells.
Magnesium sulfate calcium gluconate
mesna Cyclophosphamide A “chemoprotectant” drug that reduces the undesired effects of certain chemotherapy drugs.
Methylene blue Chemical producing severe methemoglobinemia. Ifosamide-induced encephalopathy. Reduces methemoglobin to hemoglobin.
nalmefene or naloxone Opioid analgesics Prevents or reverses the effects of opioids including respiratory depression, sedation and hypotension.
naloxone (Narcan) Narcotics Naloxone is believed to antagonize opioid effects by competing for the µ, κ and σ opiate receptor sites in the CNS, with the greatest affinity for the µ receptor.
Neostigmine Anticholinergics Anticholinesterase which causes accumulation of acetylcholine at cholinergic receptor sites.
Nitrite, sodium and glycerytrinitrate Cyanide Oxidizes hemoglobin to methemoglobin which binds the free cyanide and can enhance endothelial cyanide detoxification by producing vasodilation.
Penicillamine Copper, gold, lead, mercury, zinc, arsenic Chelation of metal ions.
phentolamine (Regitine) Dopamine Regitine produces an alpha-adrenergic block of relatively short duration. It also has direct, but less marked, positive inotropic and chronotropic effects on cardiac muscle and vasodilator effects on vascular smooth muscle.
phyostigmine or NaHCO3 Tricyclic antidepressants A reversible anticholinesterase which effectively increases the concentration of acetylcholine at the sites of cholinergic transmission.
Phytomenadione (Vitamin K.) Coumadin/Warfarin Bypasses inhibition of Vitamin K epoxide reductase enzyme.
protamine sulfate Heparin Protamine that is strongly basic combines with acidic heparin forming a stable complex and neutralizes the anticoagulant activity of both drugs.
Pyridoxine Isoniazid, theophylline, monomethyl hydrazine. Adjunctive therapy in ethylene glycol poisoning. Reverses acute pyridoxine deficiency by promoting GABA synthesis. Promotes the conversion of toxic metabolite glycolic acid to glycine.
Snake anti-venin Cobra bite Neutralizes venom by binding with circulating venom components and with locally deposited venom by accumulating at the bite site.
Sodium Bicarbonate Iron Prevents convertion of ferrous to ferric.
Cardiotoxic drug affecting fast sodium channel (TCA, cocaine) Decreases affinity of cardiotoxic drugs to the fast sodium channel.
Weak acids Promotes ionization of weak acids.
Chlorine gas inhalational poisoning Neutralization of hydrochloric acid formed when chlorine gas reacts with water in the airways.
Sodium thiosulphate Cyanide Replenishes depleted thiosulphate stores by acting as sulfur donor necessary for the conversion of CN-O to thiocyanate through the action of sulfur transferase enzyme rhodanese.
Thiamine Alcohol, Wernicke-Korsakoff Syndrome Reverses acute thiamine deficiency
Adjunctive in ethylene glycol Enhances detoxification of glyoxylic acid.
Vitamin C Chemicals causing methemoglobinemia in patients with G6PD deficiency Reduces methemoglobin to hemoglobin.


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