ANTIDOTE CHART - California Poison Control System

California Poison Control SystemGeneric/BrandnameAtropineAntivenom,CrotalidaePolyvalent ImmuneFab (ovine)/CroFab®Antivenom, BlackWidowSpider/AntivenomLatrodectusMactans®BAL (Dimercaprol)/BAL in oil 10%Calcium ChlorideInjectionCalcium GluconatepowderCalcium GluconateInjectionDMSA (Succimer)/Chemet®DTPA-Calcium(Diethylenetriaminepentaacetate)/Pentetate CalciumTrisodium InjectionDTPA-Zinc(Diethylenetriaminepentaacetate)/Pentetate ZincTrisodium InjectionCalcium GluconateGel/Calgonate 2.5%gel®Carnitine (Lcarnitine)/Carnitor®Deferoxamine/Desferal®Digoxin Immune Fab(ovine)/Digibind® orDigiFab®EDTA-Calcium/Versenate®Ethanol IV 10% with5% DextroseEthanol oral/VodkaANTIDOTE CHART(Suggested Stocking Level is based on dose to treat a 100kg patientfor 8 hours and for 24 hours)*Toxin Notes Suggested Stocking LevelOrganophosphate/Carbamate insecticidepoisoning and othercholinesterase inhibitors(e.g., warfare agents);bradycardia induced byvarious agentsRattlesnake envenomationBlack Widow SpiderenvenomationMay require largeamounts in severecholinesterase inhibitorpoisoning. Also stocked inthe Strategic NationalStockpile but will needsupplies for first 48 hours.Coordinate with localHomeland Security office.Equine base and risk ofhypersensitivity8 hours: 100 mg or 13 vials(0.4mg/mL, 20 mL each)24 hours: 200 mg or 26 vials(0.4mg/mL, 20 mL each)Use preservative free product8 hours: 12 vials24 hours: 18 vials, may need upto 35 vials for treatment8 hours:1 vial24 hours: 1 vialHeavy Metal poisoning IM administration only 8 hours: 600 mg or 2 amps(100mg/mL, 3 mL each)24 hours: 1800 mg or 6 amps(100mg/mL, 3 mL each)Calcium Channel Blockerpoisoning; hypocalcemiainduced by various agentsHydrofluoric acidHydrofluoric acid skinexposure or poisoning;hypocalcemia induced byvarious agentsHydrofluoric acid dermalburnsCan cause tissue necrosisif extravasation occurs –use large vein for infusion.For manufacture of topicalgelFor topical Hydrofluoricacid burns8 hours: 10 g or 10 vials (10 mL,10 %)24 hours: 10 g or 10 vials (10mL, 10 %)1 x 100g powder bottle8 hours: 30 g or 30 vials (10 mL,10 %)24 hours: 30 g or 30 vials (10mL, 10 %)6 x 25 g tubesHyperammonemia fromValproic acid toxicityUse IV8 hours: 10g or 10 x 1 g vials24 hours: 19 g or 19 x 1 g vialsIron poisoning IV Use ONLY 8 hours: 12 g or 6 x 2 g vials24 hours: 36 g or 18 x 2 g vialsDigoxin poisoning; othercardiac glycosides (e.g.,Oleander, foxglove plants)Heavy Metal poisoningDirty Bomb agents;Radioactive plutonium,americium and curiumDirty Bomb agents;Radioactive plutonium,americium and curiumHeavy Metal poisoningEthylene glycol orMethanol poisoningEthylene glycol orMethanol poisoningConsult with poison centerregarding dosing,especially for cardiacglycosides other thandigoxinStocked in the StrategicNational Stockpile but willneed supplies for first 48hours. Coordinate withlocal Homeland Securityoffice.Stocked in the StrategicNational Stockpile but willneed supplies for first 48hours. Coordinate withlocal Homeland Securityoffice.Note IV 10% ethanolproduct no longermanufactured.Fomepizole easier to doseand monitor than ethanol.Fomepizole easier to doseand monitor than ethanol.Oral ethanol can be usedin an emergency situation.8 hours: 15 vials of eitherproduct24 hours: 20 vials of eitherproduct8 hours: 1 g or 10 x 100 mgcapsules24 hours: 3 g or 30 x 100 mgcapsules8 hours: 1 x 1gm ampule24 hours: 1 x 1gm ampule8 hours: 1 x 1gm ampule24 hours: 1 x 1gm ampule8 hours: 1 g or 1 amp24 hours: 3 g or 3 amps8 hours: 2 bottles (1 L each)24 hours: 4 bottles (1 L each)Note: can be prepared with95% ethanol product.8 hours: 1 pint24 hours: 750mlFlumazenil/ Benzodiazepines Use small initial dose to 8 hours: 6 mg or 6 x 1 mg/10

Romazicon®Fomepizole (4-MP)/Antizol®GlucagonHydroxycobalamin/Cyanokit®Preferred antidote forEthylene glycol orMethanol poisoningBeta-blocker/CalciumChannel blocker poisoningCyanide poisoningavoid abrupt awakening/delirium. Do not use inpatients on chronicbenzodiazepine therapy aswithdrawal will occur.Manufacturers will replaceexpired stocksAnticipate nausea andvomitingSafer to use than thenitrites found in theconventional cyanideantidote kit.mL vials24 hours: 12 mg or 12 x 1mg/10 mL vials8 hours: 1.5 g or 1 x 1.5mL(1g/mL) vials24 hours: 6.0 g or 4 x 1.5 mL(1g/mL) vials8 hours: 90 mg or 90 x 1 mgkits24 hours: 250 mg or 250 x 1 mgkits8 hours: 10 g or 2 kits24 hours: 10 g or 2 kitsMethylene Blue Methemoglobinemia 8 hours: 400 mg or 4 x 10mL(10 mg/mL) amps24 hours: 600 mg or 6 x 10mL(10mg/mL) ampsN-Acetylcysteine(NAC)/ Mucomyst®or generic (oralpreparation)N-Acetylcysteine(NAC)/ Acetadote®(IVpreparation)Naloxone/Narcan®Octreotide acetate/Sandostati n®D-Penicilliamine/Cupramine®Physostigmine/Antilirium®Pralidoxime (2-PAM)/Protopam®Prussian Blue/Radiogardase®Pyridoxine (VitaminB 6 )Vitamin K 1(Phytonadione)/Mephyton® orAquaMephyton®Acetaminophen poisoningAcetaminophen poisoningOpiate and OpioidoverdoseOral Sulfonylurea poisoningHeavy Metal poisoningAnticholinergic poisoningespecially antimuscarinicagitated deliriumCholinesterase inhibitorpoisoning(Organophosphate or“nerve gas” agent)poisoningDirty bomb agents;radioactive cesium,thallium and nonradioactivethalliumIsoniazid (INH) poisoningWarfarin, warfarin-basedanticoagulants and superwarfarinbased rodenticidepoisoningUse orally. Dilute at leastby a 3:1 ratio.Loading dose should beinfused slowly over 45-60minutes. Generic N-acetylcysteine can be usedIV if Acetadote® is notavailable (consult withpoison center and give viamicropore filter).Use small initial dose toavoid abrupt awakening/delirium.Avoid long-acting depotproducts.Possible cross-sensitivityin patients allergic topenicillinAdminister at low dose(0.5 mg) and slowly(over2-5 mins)to avoid severeside effects includingbradycardia, asystole andseizures(contraindicatedin TCA poisoning)Also stocked in theStrategic NationalStockpile but will needsupplies for first 48 hours.Coordinate with localHomeland Security officeStocked in the StrategicNational Stockpile but willneed supplies for first 48hours. Coordinate withlocal Homeland SecurityofficeLarge amounts needed forpoisoning: 5 grams is theminimum antidotal doseused in an ingestion of anunknown amount. Note:the 100 mg in 1 ml vialscontain the preservativechlorobutanol. A 5 gramdose requires 50 vials andwill deliver a toxic dose ofthe preservativeIf patient activelybleeding, use fresh frozenplasma or Factor VIIconcentrate8 hours: 28 g or 5 x 30mL (20%)vials24 hours: 56 g or 10 x 30 mL(20%) vials8 hours: 24 g or 1 carton of 4 x30mL (20%) vials24 hours: 30 g or 5 x 30 mL(20%) vials8 hours: 20 mg or 50 x0.4mg/2mL amps or 2 x10mg/10mL vials24 hours: 40 mg or 4 x10mg/mL vials8 hours: 200 mcg or 2 x 1mL(0.1mg/mL) amps24 hours: 1000 mcg or1 x 5ml (0.2mg/mL) MDV8 hours: 500 mg or 2 x 250mgcapsules24 hours: 1500 mg or 6 250 mgtitratable tablets8 hours: 4 mg or 2 x 2mL(1mg/mL) amps24 hours: 20 mg or 10 x 2 mL(1 mg/mL) amps8 hours: 7 g or 7 x 1gm (20mL)vials24 hours: 18 g or 18 x 1gm(20mL) vialsMinimum order is 25 bottles(30 capsules each)8 hours: 9 g or 3 vials(100mg/mL, 30 mL each) or theequivalent (Use preservativefree product.)24 hours: 24 g or 8 vials(100mg/mL, 30 mL each) or theequivalent8 hours: 50 mg or 10 x 5mgtabs or 5 x 10mg/mL amps24 hours: 100 mg or 20 x 5 mgtabs or 10 x 10mg/mL ampsExpert advice regarding use of antidotes is available 24 hours a day/7 days a week from the California PoisonControl System**. Call us at:

1-800-222-1222*Adapted from Dart RC et al. Annals of Emergency Medicine. 2009; 54(3):386-394.Updated Dec 2010**The California Poison Control System is part of the University of California San Francisco School of Pharmacy, Department of Clinical Pharmacy and isresponsible to the California Emergency Medical Services Authority.Copyright Regents, University of California San Francisco