Last updated: March 2017
Antidote Chart (PDF, 7 pages, 286 KB)
For medical centers choosing to stock antidotes, the suggested stocking level is based on the dose needed to treat a single 100 kg patient for 8 hours and for 24 hours [Adapted from Dart RC, et al., Annals of Emergency Medicine, 2009; 54(3):386-394]. Medical centers that might expect to receive large numbers of patients in a single incident should stock larger amounts of antidotes or have an effective and efficient drug sharing/transfer procedure in place to rapidly obtain additional antidotal supplies.
Generic/ Name Brand |
Indications |
Notes |
Suggested Stocking Level |
Access Priority |
---|---|---|---|---|
Atropine |
Organophosphate/ carbamate insecticide poisoning and other cholinesterase inhibitors (eg, warfare agents); bradycardia induced by a variety of toxins |
May require large amounts in severe cholinesterase inhibitor poisoning. Also stocked in the Strategic National Stockpile: for mass casualties, the SNS may provide supplies for first 48 hours (coordinated by state department of health and emergency response system). |
8 Hours: 100 mg or 13 vials (0.4 mg/mL, 20 mL each) 24 Hours: 200 mg or 26 vials (0.4 mg/mL, 20 mL each) Use preservative-free product |
Immediate emergency department |
Antivenom, Crotalidae Polyvalent Immune- FAB(ovine)/ Cro-Fab® |
Rattlesnake envenomation |
8 Hours: 18 vials 24 Hours: 36 vials |
Within 1 hour |
|
Antivenom, Black Widow Spider/ Antivenom (Latrodectus Mactans)® |
Black Widow Spider envenomation |
Equine base risk of allergic hypersensitivity |
8 Hours: 1 vial 24 Hours: 1 vial |
Special Access: contact manufacturer (Merck, 800-672-6372) |
BAL(Dimercaprol)/ BAL in oil 10%® |
Heavy metal poisoning |
IM administration only |
8 Hours: 600 mg or 2 amps (100 mg/mL, 3 mL each) 24 Hours: 1800 mg or 6 amps (100 mg/mL, 3 mL each) |
Within 1 hour |
Bicarbonate, Sodium |
Sodium channel blocker (“membrane stabilizer”) toxicity & urinary alkalinization |
IV bolus dosing for reversal of sodium channel blocker toxicity; monitor alkalemia |
8 Hours: 63 g (750 mEq) or 750 mL of 8.4% solution 24 Hours: 84 g (1000 mEq) or 1 L of 8.4% solution |
Immediate emergency department |
Botulinum antitoxin/H-BAT- heptavalent |
Botulism |
Only available through the state health department (CA) or CDC |
Special Access; CDC -1-770-488-7100; California call: 1-510-231-7600 |
|
Calcium Chloride injection |
Calcium channel blocker poisoning; hypocalcemia induced by various agents |
Can cause tissue necrosis if extravasation occurs – use large vein for infusion or use calcium gluconate (see below) |
8 Hours: 10 gms or 10 vials (10%, 10 mL) 24 Hours: 10gms or 10 vials (10%, 10 mL) |
Immediate emergency department |
Calcium Gluconate Powder |
Hydrofluoric acid |
For manufacture of topical gel |
8 Hours: 1 x 100 g powder bottle 24 Hours: 1 x 100 g powder bottle |
Within 1 hour |
Calcium Gluconate injection |
Hydrofluoric acid skin exposure or poisoning; hypocalcemia induced by various agents |
8 Hours: 30 g or 30 vials (10%, 10 mL) 24 Hours: 30 g or 30 vials (10%, 10 mL) |
Immediate emergency department |
|
Calcium Gluconate gel/ Calgonate 2.5% gel® |
Hydrofluoric acid dermal burns |
For topical burns |
8 Hours: 6 x 25 gm tubes 24 Hours: 10 x 25 gm tubes |
Within 1 hour |
Carnitine (L-Carnitine)/ Carnitor® |
Hyperammonemia from valproic acid toxicity |
8 Hours: 10g or 10 x 1 g vials 24 Hours: 20 g or 20 x 1 g vials |
Within 1 hour |
|
Cyanide Antidote Kit (Nithiodote by Hope Pharmaceuticals) |
Cyanide;sodium nitroprusside toxicity |
Conventional cyanide antidote: contains 1-10mL (300mg) vial of sodium nitrite, 1-50 mL (12.5G) vial of sodium thiosulfate (amyl nitrite inhalant ampules not included) |
2 kits for small hospitals, 6 kits for major medical centers or stock separate supplies of sodium thiosulfate and sodium nitrite vials or stock the Cyanokit® (hydroxocobalamin) antidote kit (see below) |
Immediate emergency department |
|
Cyanide |
Risk of methemoglobinemia with use. |
2 x 10 mL (3%) vials; 6 vials for major medical centers (Less expensive than the Cyanokit™ antidote kit) |
Immediate emergency department |
|
Cyanide; sodium nitroprusside toxicity |
If used alone for cyanide toxicity, may have a slow onset of action. Thiosulfate is synergistic with sodium nitrite, and the two drugs should be used together to treat cyanide poisoning whenever possible. |
2 x 50 mL (25%) vials; 6 vials for major medical centers (Less expensive than the Cyanokit™ antidote kit) |
Immediate emergency department |
Cyanokit®/ Hydroxocobalamin |
Cyanide poisoning |
Newer, safer and easier to use (but more expensive) than the conventional cyanide antidote kit. |
8 Hours: 10 g or 2 kits 24 hours: 10 g or 2 kits |
Immediate emergency department |
Cyproheptadine/ Periactin®, others |
Mild to moderate serotonin syndrome |
Anticholinergic side effects and only PO administration |
8-24 Hours: 32 mg or 8 tablets (4 mg each) |
Within 1 hour |
Dantrolene |
Malignant hyperthermia |
8 Hours: 1000 mg or 50 x 20 mg vials 24 Hours: 1300 mg or 56 vials |
Immediate emergency department |
|
Deferiprone/ Ferriprox® |
Iron overload |
Oral Chelator |
8 Hours: 3.3 g or 7 x 500 mg tablets 24 Hours: 9.9 g or 20 x 500 mg tablets |
Specialty/optional |
Deferoxamine/ Desferal® |
Iron poisoning |
IV use only |
8 Hours: 12 g or 6 x 2 g vials 24 Hours: 36 g or 18 x 2 g vials |
Within 1 hour |
Digoxin Immune FAB (ovine)/ DigiFab® |
Digoxin poisoning; other cardiac glycosides (eg, oleander, foxglove) |
Consult with poison center regarding dosing, especially for cardiac glycosides than digoxin |
8 Hours: 15 vials of either product 24 Hours: 20 vials of either product |
Immediate emergency department |
DMSA (Succimer)/ Chemet® |
Heavy metal poisoning |
8 Hours: 1 g or 10 x 100 mg capsules 24 Hours: 3 g or 30 x 100 mg capsules |
Within 1 hour |
|
DTPA-Calcium (Diethylenetriamine pentaacetate)/ Pentetate Calcium Trisodium injection) |
Dirty bomb agents: radioactive plutonium, americium and curium |
Only available through government sources. Stocked in the Strategic National Stockpile: supplies for first 48 hours coordinated by state department of health and emergency response system. |
8 Hours: 1 x 1 g amp 24 Hours: 1 x 1 g amp |
Special access - Strategic National Stockpile. The Radiation Emergency Assistance Center/Training Site (REAC/TS) can be contacted for information on use of antidote. business hours: 1-865-576-3131; after hours: 1-865-576-1005. |
DTPA-Zinc (Diethylenetriamine pentaacetate)/ Pentetate Zinc Trisodium injection) |
Dirty bomb agents: radioactive plutonium, americium and curium |
Only available through government sources. Stocked in the Strategic National Stockpile: supplies for first 48 hours coordinated by state department of health and emergency response system. |
8 Hours: 1 x 1 g amp 24 Hours: 1 x 1 g amp |
Special access - Strategic National Stockpile. The Radiation Emergency Assistance Center/Training Site (REAC/TS) can be contacted for information on use of antidote. business hours: 1-865-576-3131; afterhours: 1-865-576-1005. |
EDTA-Calcium/ Versenate® |
Heavy metal poisoning |
Note: Do not confuse with “Sodium” EDTA |
8 Hours: 1 g or 1 1000 mg/5mL amp 24 Hours: 3 g or 3 1000 mg/5mL amps |
Within 1 hour |
Ethanol IV 10% with 5% Dextrose |
Ethylene glycol or methanol poisoning |
Note: IV 10% ethanol product no longer manufactured; fomepizole easier to dose and monitor than ethanol |
8 Hours: 22 x (5-mL) vials or ampules of 98% solution for injection 24 Hours: 44 x (5-mL) vials or ampules (10% solution can be prepared using 98% ethanol product) |
Within 1 hour |
Ethanol (oral) |
Ethylene glycol or methanol poisoning |
Fomepizole easier to dose and monitor than ethanol. Oral ethanol-containing beverage (eg, whiskey, vodka) can be used in an emergency situation. |
8 Hours: one pint 24 Hours: 750mL |
Within 1 hour |
Flumazenil/ Romazicon® |
Benzodiazepine poisoning |
Use small initial dose to avoid abrupt awakening/ delirium; use with caution in patients on chronic benzodiazepine therapy as withdrawal seizures may occur; use with caution in mixed drug overdoses. |
8 Hours: 6 mg or 6 x 1mg/10 mL vials 24 Hours: 12 mg or 12 x 1 mg/10 mL vials |
Immediate emergency department |
Fomepizole (4-MP)/ Antizol®/ generics |
Preferred antidote for ethylene glycol or methanol poisoning |
Manufacturer of Antizol™ will replace expired stocks |
8 Hours: 1.5 g or 1 x 1.5mL (1g/mL) vials 24 Hours: 6.0 g or 4 x 1.5 mL (1g/mL) vials |
Immediate emergency department |
Glucagon |
Beta blocker/calcium channel blocker poisoning |
Anticipate nausea and vomiting |
8 Hours: 90 mg or 90 x 1 mg kits 24 Hours: 250 mg or 250 x 1 mg kits |
Immediate emergency department |
Glucarpidase/ Voraxaze® |
Methotrexate toxic levels |
Use in patient with toxic levels and impaired renal function; glucarpidase may also metabolize leucovorin so stagger doses at least 2 hours. |
5 vials(1000U/vial) |
Specialty/optional product accessed by 1-855-786-7292 |
Idarucizumab/ Praxbind® |
Monoclonal antibody that binds to dabigatran and its acylglucuronide metabolites and neutralizes their anticoagulant effects |
Specific only for dabigatran; not effective for other oral anticoagulants |
8 Hours: 10 g or 4 x (2.5g/50 mL) vials 24 Hours: 20 g or 8 x (2.5g/50 mL) vials |
Immediate emergency department |
Insulin |
Hyperinsulinemia - euglycemia (HIE) therapy for calcium antagonist and beta- blocker poisoning |
Accompany with dextrose if blood glucose < 200 mg/dL |
8 Hours: 1000 U or one vial (100 U/mL, 10mL each) 24 Hours: 3000 U or three vials (100 U/mL, 10mL each) |
Immediate emergency department |
Intravenous Fat Emulsion/ Intralipid® |
Lipophilic cardiotoxic drugs |
Immediately after administration several laboratory tests of patient serum/blood may be uninterpretable |
8-24 Hours: 3300 mL of 20% or 3 bags (100mL each) plus 6 bags (500 mL each) |
Immediate emergency department |
Leucovorin calcium |
Folic acid antagonists/methanol |
8-24 Hours: 300 mg or 3 (100 mg) vials |
Within 1 hour |
|
Methylene Blue |
Methemoglobinemia |
8 Hours: 400 mg or 4 x 10 mL (10 mg/mL) amps 24 Hours: 600 mg or 6 x 10 mL (10 mg/mL) amps |
Immediate emergency department |
|
N-Acetylcysteine (NAC) Mucomyst® or generic |
Acetaminophen poisoning (oral preparation) |
Use orally. Dilute at least by a 3:1 ratio. |
8 Hours: 28 g or 5 x 30 mL (20%) vials 24 Hours: 56 g or 10 x 30 mL (20%) vials |
Immediate emergency department |
N-Acetylcysteine (NAC) Acetadote® |
Acetaminophen poisoning (IV preparation) |
Note: 3 different dilutions are used for 1, 4 and 16 hour infusions. Loading dose should be infused slowly over 45-60 minutes. Generic N- acetylcysteine can be used if Acetadote® is not available (consult with poison center and administer via a micropore filter). |
8 Hours: 24 g or 4 x 30 mL (20%) vials 24 Hours: 30 g or 5 x 30 mL (20%) vials |
Immediate emergency department |
Naloxone/ Narcan® |
Opioid overdose |
Use small initial dose to avoid abrupt awakening/withdrawal |
8 Hours: 20 mg or 50 x 0.4 mg/2mL amps or 2 x 10 mg/10mL vials 24 Hours: 40 mg or 4 x 10 mg/mL vials |
Immediate emergency department |
Octreotide acetate/ Sandostatin® |
Oral sulfonylurea poisoning and meglitinide poisoning |
Avoid long-acting depot products |
8 Hours: 200 mcg or 2 x 1mL (0.1mg/mL) amps 24 Hours: 1000 mcg or 1 x 5mL (0.2mg/mL) multidose vial |
Within 1 hour |
Physostigmine/ Antilirium® |
Anticholinergic poisoning, especially antimuscarinic delirium |
Administer at low dose (0.5 mg) and slowly, over 2-5 minutes to avoid severe adverse reactions including bradycardia, asystole and seizures (Contraindicated in TCA or similar poisoning with widened QRS intervals) |
8 Hours: 4 mg or 2 x 2mL (1mg/mL) amps 24 Hours: 20 mg or 10 x 2 mL (1 mg/mL) amps |
Immediate emergency department |
Pralidoxime(2-PAM)/ Protopam® |
Cholinesterase Inhibitor poisoning (organophosphate or “nerve gas”) |
Also stocked in the Strategic National Stockpile: for mass casualties, local cache may provide supplies for first 48 hours coordinated by state department of health and emergency response system. |
8 Hours: 7 g or 7 x 1 gm (20 mL) vials 24 Hours: 18 g or 18 x 1 gm (20 mL) vials |
Within 1 hour |
Protamine |
Heparin reversal |
May also partially neutralize low-molecular weight heparins |
8-24 Hours: 500 mg or 2 vials (10mg/mL, 25 mL each) |
Within 1 hour |
Prussian Blue/ Radiogardase® |
Dirty bomb agents: radioactive cesium and thallium and non-radioactive thallium |
Only available through government sources. Stocked in the Strategic National Stockpile: will provide supplies for first 48 hours coordinated by state department of health and emergency response system. |
Minimum order is 25 bottles (30 capsules each) |
Special access - Strategic National Stockpile. The Radiation Emergency Assistance Center/Training Site (REAC/TS) can be contacted for information on use of antidote. business hours: 1-865-576-3131; afterhours: 1-865-576-1005. |
Pyridoxine (Vitamin B6) |
Isoniazid (INH) poisoning |
Large amounts needed for poisoning: 5 grams is the minimum antidotal dose used in an ingestion of an unknown amount. Note: the 30 mL vials may only be available from compounding pharmacies. The 100 mg in 1 mL vials may contain the preservative chlorobutanol. A 5 gram dose requires 50 of these vials and may deliver a toxic dose of the preservative. |
8 Hours: 9 g or 3 vials (100 mg/mL, 30 mL each) or the equivalent 24 Hours: 24 g or 8 vials (100 mg/mL, 30 mL each) or the equivalent (Use preservative free product.) |
Immediate emergency department |
Sugammadex (BridionR) |
Reversal of rocuronium and vecuronium (and possibly pancuronium) neuromuscular blockade. Emergent reversal dosing depends on the depth of the paralysis and can range from 2 mg/kg up to 16 mg/kg. |
This agent is used in lieu of carbamate (cholinergic) reversal agents such as neostigmine. More info at sugammadex sodium. |
Available in two vial sizes: 200 mg/2 mL (100 mg/mL) in a single-dose vial for bolus injection (comes in a box of 10 vials) Or 500 mg/5 mL (100 mg/mL), in a single-dose vial for bolus injection (comes in a box of 10 vials) |
Immediate- stock in areas where accidental administration of paralytics may occur (Emergency Department of Operating Room) |
Uridine triacetate/ Vistogard® |
5-FU, capecitabine poisoning |
Recommended for use within 96 hours of last dose where toxicity is evident or expected; doses of up to 10 grams every 6 hours for a total of 20 doses have been well-tolerated. |
8 Hours: 20 g or 2 x 10 g packets 24 Hours: 40 g or 4 x 10 g packets |
BTG Specialty Solutions Center: 1-844-293-0007. Vistogard® is distributed exclusively through Cardinal Health (“SPD”), available 24/7 |
Vitamin K1(Phytonadione)/ Mephyton® or AquaMephyton® |
Warfarin, warfarin-based anticoagulants and super- warfarin based rodenticide poisoning |
If patient is actively bleeding use fresh frozen plasma or Factor VII concentrate |
8 Hours: 50 mg or 10 x 5 mg tabs or 5 x 10 mg/mL amps 24 Hours: 200 mg or 40 x 5 mg tabs or 20 x 10 mg/mL amps |
Within 1 hour |
Note: List is not all-inclusive but reflects agents used more exclusively as antidotes or antidotal agents used infrequently.