Antidotes- Toxicology
what are Antidote?Antidote are substances which oppose the effects of poisons without causing damage to body
Types of Antidotes
1:Mechanical or physical antidote:
these substances prevents the absorption of poison by their presence
eg:demulcents(fats,oils,milk,eggalbumin) are used for corrosive and irritant poisoning,Bulky food used for glass poisoning ,Activated charcoal is used for strychinine and mineral poisoning(dose 30-60 gms for childreb and 60-100gms ofr adults)
2:chemical antidotes:these substances neutrilize the chemical action or oxidize the poison into
nontoxic or insolouble form
eg:Dilute acetic acid,dilute alkali(milk of magnesia),tannin(strong tea),potassium
permangante
3:physiological or pharmacological antidotes
these produce effects opposite to that of poison
eg:atropine and oxime for organophosphorous poison,naloxone for morphine, N-acetylcysteine for acetaminophen
4:chelating agents:
these are substances which produce form chelates(non ionized comlexes) with cations...these are mostly used in heavymetal poisoning
eg:EDTA is used in Arsenic,mercury,lead
BAL(dimercepol) is used in heavy metal poisons versenate is used in Arsenic,mercury and lead N-pencillamine for mercury,lead,copper Desferoxamine is used for iron
Antidotes to Common Poisons:
Poison---Antidote Acetominophen NAC(N-acetylcysteine) Anticholinergics Physostigmine
Anticoagulants (warfarin/coumadin,heparin) Vitamin K1, protamine. Benzodiazepines Supportive Care, Flumazenil* Botulism Botulinum Antitoxin
Beta Blockers Glucagon
Calcium Channel Blockers Calcium, ?Glucagon?
Cholinergics Atropine, Pralodixime in Organophosphate Overdose Carbon Monoxide Oxygen, Hyperbaric Oxygen
Cyanide
Amyl Nitrate, Sodium Nitrate, Sodium Thiosulfate, Hydroxycobalamin (Available in Europe).
Digoxin Digoxin Fab Antibodies
Iron Deferoxamine
Isoniazid Pyridoxine
Lead BAL, EDTA, DMSA Methemoglobinemia Methelene Blue
Opiods Naloxone
Toxic Alcohols Ethanol Drip, Dialysis. Experimental trials underway on Enzyme Inhibitors.
Tricyclic Antidepressants Sodium Bicarbonate
*Use of flumazenil contraindicated in many situations including tricyclic overdose or in chronically habituated benzodiazepine users, as this may precipitate seizures.
Disclaimer!: Once again, this is useful as an educationa tool, and may not represent standard of care in your area. Please consult a poison control center in case of emergency.
Antidotes to Common Poisons:
Poison---Antidote Acetominophen NAC(N-acetylcysteine) Anticholinergics Physostigmine
Anticoagulants (warfarin/coumadin,heparin) Vitamin K1, protamine. Benzodiazepines Supportive Care, Flumazenil* Botulism Botulinum Antitoxin
Calcium Channel Blockers Calcium, ?Glucagon?
Cholinergics Atropine, Pralodixime in Organophosphate Overdose Carbon Monoxide Oxygen, Hyperbaric Oxygen
Cyanide
Amyl Nitrate, Sodium Nitrate, Sodium Thiosulfate, Hydroxycobalamin (Available in Europe).
Digoxin Digoxin Fab Antibodies
Iron Deferoxamine
Isoniazid Pyridoxine
Lead BAL, EDTA, DMSA Methemoglobinemia Methelene Blue
Opiods Naloxone
Toxic Alcohols Ethanol Drip, Dialysis. Experimental trials underway on Enzyme Inhibitors.
Tricyclic Antidepressants Sodium Bicarbonate
*Use of flumazenil contraindicated in many situations including tricyclic overdose or in chronically habituated benzodiazepine users, as this may precipitate seizures.
Disclaimer!: Once again, this is useful as an educationa tool, and may not represent standard of care in your area. Please consult a poison control center in case of emergency.
An antidote is a substance which can counteract a form of poisoning.[1] The term ultimately derives from the Greek αντιδιδοναι antididonai, "given against".
The antidotes for some particular toxins are manufactured by injecting the toxin into an animal in small doses and extracting the resulting antibodies from the host animals' blood. This results in an
antivenom that can be used to counteract poison produced by certain species of snakes, spiders, and other venomous animals. A number of venoms lack a viable antivenom, and a bite or sting from an animal producing such a toxin often results in death. Some animal venoms, especially those produced by arthropods (e.g. certain spiders, scorpions, bees, etc.) are only potentially lethal when they provoke allergic reactions and induce anaphylactic shock; as such, there is no "antidote" for these venoms because it is not a form of poisoning and anaphylactic shock can be treated (e.g., by the use of epinephrine).
Some other toxins have no known antidote. For example, the poison aconitine, a highly poisonous
alkaloid derived from various aconite species has no antidote, and as a result is often fatal if it enters the human body in sufficient quantities.
Mechanical approaches
Ingested poisons are frequently treated by the oral administration of activated charcoal, which
adsorbs the poison and flushes it from the digestive tract, thereby removing a large part of the toxin.A remedy:
Poisons which are injected into the body (such as those from bites or stings from venomous
animals) are usually treated by the use of a constriction band which limits the flow of lymph and/or blood to the area, thus slowing circulation of the poison around the body. This should not be
confused with use of a tourniquet which cuts off blood flow completely - often leading to the loss of the limb.
List of antidotes
Agent Indication
Activated charcoal with sorbital used for many oral toxins
Atropine
organophosphate and carbamate
insecticides, nerve agents, some
mushrooms
Beta Blocker theophylline
Calcium chloride calcium channel blockersspider bites , black widow
Calcium gluconate hydrofluoric acid
Chelators such as EDTA, dimercaprol (BAL),
penicillamine, and 2,3-dimercaptosuccinic acid
(DMSA, succimer) heavy metal poisoning
Cyanide antidote (amyl nitrite, sodium nitrite, or
thiosulfate) cyanide poisoning
Cyproheptadine serotonin syndrome
Deferoxamine mesylate Iron poisoning
Digoxin Immune Fab antibody (Digibind and Digifab) digoxin poisoning
Diphenhydramine hydrochloride and benztropine
mesylate Extrapyramidalantipsychotic reactions associated with Ethanol or fomepizole ethylene glycol poisoning and methanol
poisoning
Flumazenil benzodiazepine poisoning
Glucagon beta blockerchannel blocker poisoning and poisoning calcium
100% oxygen or hyperbaric oxygen therapy (HBOT) carbon monoxidepoisoning poisoning and cyanide
Insulin beta blocker poisoning and calcium
channel blocker poisoning
Leucovorin methotrexate and trimethoprim
Methylene blue treatment of conditions that cause methemoglobinemia fritz pogi Naloxone hydrochloride opioid poisoning
N-acetylcysteine Paracetamol (acetaminophen) poisoning
Octreotide oral hypoglycemic agents
Pralidoxime chloride (2-PAM) organophosphate insecticides
Protamine sulfate Heparin poisoning
Prussian blue Thallium poisoning
Physostigmine sulfate anticholinergic poisoning
Pyridoxine Isoniazid poisoning, ethylene glycol
Phytomenadione (vitamin K) and fresh frozen plasma warfarin poisoning and indanedione Sodium bicarbonate ASA, TCAs with a wide QRS