Category Toxicology Library
Toxicology-Library-Antidote-340-256

Naloxone

This opioid antagonist is a useful adjunct in the management of opioid intoxication, particularly if there is CNS or respiratory depression. Caution is advised in those who are opiate-dependant and naloxone should only be used if there is significant CNS (GCS <12) and respiratory depression (RR <8).
Toxicology-Library-Antidote-340-256

N-acetylcysteine

N-acetylcysteine (NAC) is the most widely used sulfhydryl donor in the treatment of paracetamol poisoning. Standard therapy consists of a series of three infusions given over 20 hours.
Toxicology-Library-Antidote-340-256

Methylene blue

Methylene Blue is the treatment of choice for symptomatic drug-induced methaemoglobinaemia (signs of hypoxia with chest pain, dyspnoea or confusion) or consider in asymptomatic patients with methaemoglobin (MetHb) levels >20%.
Toxicology-Library-Antidote-340-256

Intravenous lipid emulsion

Intravenous lipid emulsion (IVLE) is a sterile emulsion of soyabean oil in water, used in parenteral nutrition. It is a novel antidote which requires further study but may have a role to play in the resuscitation of patients with refractory cardiac arrest induced by local anaesthetics that are resistant to standard protocols.
Toxicology-Library-Antidote-340-256

Insulin (High dose)

High-dose insulin therapy is a novel therapeutic intervention that produces a significant inotropic response in severe calcium channel blocker (CCB) overdose and occasionally in beta blocker overdose.
Toxicology-Library-Antidote-340-256

Idarucizumab

Idarucizumab is the antidote to dabigatran. Perhaps the hardest thing about it is saying its name. Eye-da-roo-ciz-oo-mab or praxbind until to comes off label. It is a humanised monoclonal antibody fragment (Fab) that binds to dabigatran with very high affinity (340x fold more than dabigatran binds to thrombin).
Toxicology-Library-Antidote-340-256

Hydroxocobalamin

Hydroxocobalamin is a vitamin B12 (cyanocobalamin) precursor. In high doses, it is an effective chelator of cyanide. It is also the preferred antidote to cyanide poisoning due to its low side effect profile, thus if given to a patient without cyanide poisoning there is low risk of an adverse outcome
Toxicology-Library-Antidote-340-256

Glucose

Symptomatic hypoglycaemia resulting from toxic exposures must be immediately corrected by administration of glucose. In all but the mildest of cases this is achieved with an intravenous bolus of hypertonic glucose solution
Toxicology-Library-Antidote-340-256

Fomepizole

Fomepizole is an alcohol dehydrogenase inhibitor used in management of methanol and ethylene glycol poisoning. It is not currently available in either Australia or New Zealand.
Toxicology-Library-Antidote-340-256

Glucagon

Polypeptide hormone secreted by the alpha-cells of the pancreas. Supra-physiological doses have previously been advocated in the management of beta-blocker and calcium channel blocker poisoning but this practice is now largely abandoned.
Toxicology-Library-Antidote-340-256

Folinic Acid

Folinic acid is the active form of folic acid. It is routinely used for “folinic acid rescue therapy” following administration of high-doses of parenteral methotrexate in oncologic practice.
Toxicology-Library-Antidote-340-256

Flumazenil

Flumazenil is a competitive benzodiazepine antagonist with a limited role in the management of benzodiazepine poisoning. Usually to reverse procedural sedation, accidental paediatric ingestion with compromise, and rarely to help make a diagnosis of benzodiazepine overdose or if a patient's airway is compromised without quick access to intubation equipment