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California Poison Control System

   ANTIDOTE CHART
 (Suggested Stocking Level is based on dose to treat a 70 kg patient for 24 hours)*
                                                         Updated: 3-11-2008

                                                                                                                 Suggested
    Generic/ Name Brand                            Toxin                             Notes                        Stocking
                                                                                                                   Level
                                                                       May require large amounts in
                                        Organophosphate/Carbamate
                                                                       severe cholinesterase inhibitor
                                        insecticide poisoning and
                                                                       poisoning. Also stocked in the      1000 mg total (in vials)
                                        other cholinesterase
Atropine                                                               Strategic National Stockpile but    Use preservative free
                                        inhibitors (eg, warfare
                                                                       will need supplies for first 48     product
                                        agents); bradycardia induced
                                                                       hours. Coordinate with local
                                        by a variety of toxins
                                                                       Homeland Security office.
Antivenom, Crotalidae Polyvalent
                             ®          Rattlesnake envenomation                                           24 vials
Immune-FAB(ovine)/ Cro-Fab
Antivenom, Black Widow Spider/
                                        Black Widow Spider
Antivenom (Latrodectus                                                                                     1 x 6000u vial
        ®                               envenomation
Mactans)
BAL(Dimercaprol)/ BAL in oil                                                                               6 x 3 mL (10% in oil)
                                        Heavy Metal poisoning
10%®                                                                                                       amps
                                        Calcium channel blocker        Can cause tissue necrosis if
Calcium Chloride injection              poisoning; hypocalcemia        extravasation occurs – use large    20 x 10mL (10%) vials
                                        induced by various agents      vein for infusion.

Calcium Gluconate Powder                Hydrofluoric Acid              For manufacture of topical gel      1 x 100gm powder bottle

                                        Hydrofluoric Acid skin
                                        exposure or poisoning;
Calcium Gluconate injection                                                                                20 x 10mL (10%) vials
                                        hypocalcemia induced by
                                        various agents
Calcium Gluconate gel/Calgonate         Hydrofluoric Acid dermal
         ®                                                             For topical burns                   6 x 25 gm tubes
2.5% gel                                burns
                                    ®   Hyperammonemia from
Carnitine (L-Carnitine)/ Carnitor                                                                          7 x 1gm vials
                                        valproic acid toxicity
                                                                       Thiosulfate component can be        2 kits (or stock the
Cyanide Antidote Kit/ Taylor
                                        Cyanide poisoning              used separately. See also           Cyanokit® - see
Cyanide Antidote Kit®
                                                                       Hydroxocobalamin (Cyanokit®).       Hydroxocobalamin)

Deferoxamine/ Desferal®                 Iron poisoning                 IM administration is discouraged.   12 x 500mg vials

                                        Digoxin poisoning; Other       Consult with poison center
Digoxin Immune FAB (ovine)/                                                                                15 vials of either
                                        cardiac glycosides (eg,        regarding dosing, especially for
Digibind® or DigiFab®                                                                                      product
                                        oleander, foxglove)            cardiac glycosides than digoxin.

DMSA (Succimer)/ Chemet®                Heavy metal poisoning                                              1 x 100 capsule bottle

                                                                       Also stocked in the Strategic
DTPA-Calcium
                                        Dirty bomb agents:             National Stockpile but will need
(Diethylenetriamine pentaacetate)/
                                        Radioactive plutonium,         supplies for first 48 hours.        1 x 1gm vial
Pentetate Calcium Trisodium
                                        americium and curium           Coordinate with local Homeland
injection)
                                                                       Security office.
                                                                       Also stocked in the Strategic
DTPA-Zinc (Diethylenetriamine           Dirty bomb agents:             National Stockpile but will need
pentaacetate)/ Pentetate Zinc           Radioactive plutonium,         supplies for first 48 hours.        1 x 1gm vial
Trisodium injection)                    americium and curium           Coordinate with local Homeland
                                                                       Security office.

EDTA-Calcium/ Versenate®                Heavy metal poisoning                                              18x 1000mg/5mL amps

                                                                       Note: Ethanol more difficult to
                                        Ethylene glycol or Methanol                                        Product no longer
Ethanol IV 10%                                                         obtain, dose and monitor than
                                        poisoning                                                          manufactured
                                                                       fomepizole.
Use small initial dose to avoid
  Flumazenil/ Romazicon®              Benzodiazepine poisoning                                              5 x 0.5 mg/5mL vials
                                                                     abrupt awakening/ delirium.
                                      Preferred antidote for
                                                                     Manufacturer will replace expired      4 x 1.5mL (1gm/mL)
  Fomepizole (4-MP)/ Antizol®         Ethylene glycol or Methanol
                                                                     stocks.                                vials
                                      poisoning
                                      Beta blocker/ Calcium
  Glucagon                                                           Anticipate nausea and vomiting.        10 x 1 mg vials
                                      channel blocker poisoning
                                                                     Newer cyanide antidote, can be
                                  ®                                                                         3 x 5gm kits (or stock
  Hydroxycobalamin/ Cyanokit          Cyanide poisoning              used instead of the conventional
                                                                                                            the Taylor cyanide kit)
                                                                     cyanide antidote kit from Taylor.
                                                                                                            5 x 10mL (1%) amps
  Methylene Blue                      Methemoglobinemia
                                                                                                            (10mg/mL)
  N-Acetylcysteine (NAC)              Acetaminophen poisoning        Use orally. Dilute at least by a 3:1
                                                                                                            7 x 30mL (20%) vials
  Mucomyst® or generic                (oral preparation)             ratio.
                                                                     Loading dose should be infused
                                                                     slowly over 45-60 minutes.
  N-Acetylcysteine (NAC)              Acetaminophen poisoning        Generic N-acetylcysteine can be        1 carton of 4 x 30mL
            ®
  Acetadote                           (IV preparation)               used if Acetadote® is not available    (20%) vials
                                                                     (consult with poison center and
                                                                     give via micropore filter).
                                                                     Use small initial dose to avoid        20 x 0.4mg/2mL amps or
  Naloxone/ Narcan®                   Opioid overdose
                                                                     abrupt awakening/ delirium.            10 x 10mg/10mL vials
                                                                                                            2 x 1mL (0.1mg/mL)
  Octreotide acetate/ Sandostatin®    Oral sulfonylurea poisoning    Avoid long-acting depot products.      amps
                                                                                                            1 x 5ml 0.2mg/1ml MDV
                                      Anticholinergic poisoning,     Administer slowly: May cause
                              ®
  Physostigmine/ Antilirium           especially antimuscarinic      severe side effects including          10 x 2mL (1mg/mL) vials
                                      delirium.                      bradycardia, asystole and seizures
                                                                     Also stocked in the Strategic
                                      Cholinesterase Inhibitor       National Stockpile but will need
  Pralidoxime(2-PAM)/ Protopam®       poisoning (organophosphate     supplies for first 48 hours.           12 x 1gm (20mL) vials
                                      or “nerve gas”)                Coordinate with local Homeland
                                                                     Security office.
                                                                     Also stocked in the Strategic
                                      Dirty bomb agents:
                                                                     National Stockpile but will need
                                  ®   radioactive cesium and                                                2 packs of thirty 500 mg
  Prussian Blue/ Radiogardase                                        supplies for first 48 hours.
                                      thallium and non-radioactive                                          capsules
                                                                     Coordinate with local Homeland
                                      thallium
                                                                     Security office.
                                                                     Large amounts needed for
                                                                     poisoning: 5 grams is the
                                                                     minimum antidotal dose used in
                                                                                                            50 x 1mL (100 mg/mL) or
                                                                     an ingestion of an unknown
                                                                                                            the equivalent (Use
  Pyridoxine (Vitamin B6)             Isoniazid (INH) poisoning      amount. Note: the 100 mg in 1 ml
                                                                                                            preservative free
                                                                     vials contain the preservative
                                                                                                            product.)
                                                                     chlorobutanol. A 5 gram dose
                                                                     requires 50 vials and will deliver a
                                                                     toxic dose of the preservative.
                                      Warfarin, warfarin-based
  Vitamin K1(Phytonadione)/                                           If patient is actively bleeding use
                                      anticoagulants and super-                                             20 x 5mg tabs
             ®                    ®
                                                                     fresh frozen plasma or Factor VII
  Mephyton or AquaMephyton            warfarin based rodenticide                                            10 x 10mg/mL amps
                                                                     concentrate.
                                      poisoning

Expert advice regarding use of antidotes is available 24 hours a day, 7 days a week
               from the California Poison Control System. Call us at

                                      1-800-222-1222
             *Adapted From Olson, KR (Ed): Poisoning & Drug Overdose. 5th Edition. McGraw-Hill. New York. 2007

                 Note: List is not all-inclusive but reflects agents used more exclusively as antidotes
                                          or antidotal agents used infrequently.

                                                     Updated: 3-11-2008

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Antidote chart for_cpcs_2008

  • 1. California Poison Control System ANTIDOTE CHART (Suggested Stocking Level is based on dose to treat a 70 kg patient for 24 hours)* Updated: 3-11-2008 Suggested Generic/ Name Brand Toxin Notes Stocking Level May require large amounts in Organophosphate/Carbamate severe cholinesterase inhibitor insecticide poisoning and poisoning. Also stocked in the 1000 mg total (in vials) other cholinesterase Atropine Strategic National Stockpile but Use preservative free inhibitors (eg, warfare will need supplies for first 48 product agents); bradycardia induced hours. Coordinate with local by a variety of toxins Homeland Security office. Antivenom, Crotalidae Polyvalent ® Rattlesnake envenomation 24 vials Immune-FAB(ovine)/ Cro-Fab Antivenom, Black Widow Spider/ Black Widow Spider Antivenom (Latrodectus 1 x 6000u vial ® envenomation Mactans) BAL(Dimercaprol)/ BAL in oil 6 x 3 mL (10% in oil) Heavy Metal poisoning 10%® amps Calcium channel blocker Can cause tissue necrosis if Calcium Chloride injection poisoning; hypocalcemia extravasation occurs – use large 20 x 10mL (10%) vials induced by various agents vein for infusion. Calcium Gluconate Powder Hydrofluoric Acid For manufacture of topical gel 1 x 100gm powder bottle Hydrofluoric Acid skin exposure or poisoning; Calcium Gluconate injection 20 x 10mL (10%) vials hypocalcemia induced by various agents Calcium Gluconate gel/Calgonate Hydrofluoric Acid dermal ® For topical burns 6 x 25 gm tubes 2.5% gel burns ® Hyperammonemia from Carnitine (L-Carnitine)/ Carnitor 7 x 1gm vials valproic acid toxicity Thiosulfate component can be 2 kits (or stock the Cyanide Antidote Kit/ Taylor Cyanide poisoning used separately. See also Cyanokit® - see Cyanide Antidote Kit® Hydroxocobalamin (Cyanokit®). Hydroxocobalamin) Deferoxamine/ Desferal® Iron poisoning IM administration is discouraged. 12 x 500mg vials Digoxin poisoning; Other Consult with poison center Digoxin Immune FAB (ovine)/ 15 vials of either cardiac glycosides (eg, regarding dosing, especially for Digibind® or DigiFab® product oleander, foxglove) cardiac glycosides than digoxin. DMSA (Succimer)/ Chemet® Heavy metal poisoning 1 x 100 capsule bottle Also stocked in the Strategic DTPA-Calcium Dirty bomb agents: National Stockpile but will need (Diethylenetriamine pentaacetate)/ Radioactive plutonium, supplies for first 48 hours. 1 x 1gm vial Pentetate Calcium Trisodium americium and curium Coordinate with local Homeland injection) Security office. Also stocked in the Strategic DTPA-Zinc (Diethylenetriamine Dirty bomb agents: National Stockpile but will need pentaacetate)/ Pentetate Zinc Radioactive plutonium, supplies for first 48 hours. 1 x 1gm vial Trisodium injection) americium and curium Coordinate with local Homeland Security office. EDTA-Calcium/ Versenate® Heavy metal poisoning 18x 1000mg/5mL amps Note: Ethanol more difficult to Ethylene glycol or Methanol Product no longer Ethanol IV 10% obtain, dose and monitor than poisoning manufactured fomepizole.
  • 2. Use small initial dose to avoid Flumazenil/ Romazicon® Benzodiazepine poisoning 5 x 0.5 mg/5mL vials abrupt awakening/ delirium. Preferred antidote for Manufacturer will replace expired 4 x 1.5mL (1gm/mL) Fomepizole (4-MP)/ Antizol® Ethylene glycol or Methanol stocks. vials poisoning Beta blocker/ Calcium Glucagon Anticipate nausea and vomiting. 10 x 1 mg vials channel blocker poisoning Newer cyanide antidote, can be ® 3 x 5gm kits (or stock Hydroxycobalamin/ Cyanokit Cyanide poisoning used instead of the conventional the Taylor cyanide kit) cyanide antidote kit from Taylor. 5 x 10mL (1%) amps Methylene Blue Methemoglobinemia (10mg/mL) N-Acetylcysteine (NAC) Acetaminophen poisoning Use orally. Dilute at least by a 3:1 7 x 30mL (20%) vials Mucomyst® or generic (oral preparation) ratio. Loading dose should be infused slowly over 45-60 minutes. N-Acetylcysteine (NAC) Acetaminophen poisoning Generic N-acetylcysteine can be 1 carton of 4 x 30mL ® Acetadote (IV preparation) used if Acetadote® is not available (20%) vials (consult with poison center and give via micropore filter). Use small initial dose to avoid 20 x 0.4mg/2mL amps or Naloxone/ Narcan® Opioid overdose abrupt awakening/ delirium. 10 x 10mg/10mL vials 2 x 1mL (0.1mg/mL) Octreotide acetate/ Sandostatin® Oral sulfonylurea poisoning Avoid long-acting depot products. amps 1 x 5ml 0.2mg/1ml MDV Anticholinergic poisoning, Administer slowly: May cause ® Physostigmine/ Antilirium especially antimuscarinic severe side effects including 10 x 2mL (1mg/mL) vials delirium. bradycardia, asystole and seizures Also stocked in the Strategic Cholinesterase Inhibitor National Stockpile but will need Pralidoxime(2-PAM)/ Protopam® poisoning (organophosphate supplies for first 48 hours. 12 x 1gm (20mL) vials or “nerve gas”) Coordinate with local Homeland Security office. Also stocked in the Strategic Dirty bomb agents: National Stockpile but will need ® radioactive cesium and 2 packs of thirty 500 mg Prussian Blue/ Radiogardase supplies for first 48 hours. thallium and non-radioactive capsules Coordinate with local Homeland thallium Security office. Large amounts needed for poisoning: 5 grams is the minimum antidotal dose used in 50 x 1mL (100 mg/mL) or an ingestion of an unknown the equivalent (Use Pyridoxine (Vitamin B6) Isoniazid (INH) poisoning amount. Note: the 100 mg in 1 ml preservative free vials contain the preservative product.) chlorobutanol. A 5 gram dose requires 50 vials and will deliver a toxic dose of the preservative. Warfarin, warfarin-based Vitamin K1(Phytonadione)/ If patient is actively bleeding use anticoagulants and super- 20 x 5mg tabs ® ® fresh frozen plasma or Factor VII Mephyton or AquaMephyton warfarin based rodenticide 10 x 10mg/mL amps concentrate. poisoning Expert advice regarding use of antidotes is available 24 hours a day, 7 days a week from the California Poison Control System. Call us at 1-800-222-1222 *Adapted From Olson, KR (Ed): Poisoning & Drug Overdose. 5th Edition. McGraw-Hill. New York. 2007 Note: List is not all-inclusive but reflects agents used more exclusively as antidotes or antidotal agents used infrequently. Updated: 3-11-2008