Antidote

Author: Prof. Dr. med. Peter Altmeyer

All authors of this article

Last updated on: 20.05.2022

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Definition
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Substance capable of eliminating or at least reducing the toxicity of toxins. Only for a few poisons there are specific antidotes (see Table 1), therefore the treatment of poisoning must be largely symptomatic.

Tables
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Overview of the most common antidotes and their indications

Antidote

Indication

Activated charcoal (Carbo medicinalis)

Non-specific binding of fat- and water-soluble toxins (suspension of 30-50 g in approx. 300 ml p.o., children half)

Antidotum universale (2 parts activated charcoal, 1 part tannic acid, 1 part Magnesia usta)

Sublimate poisoning

Apomorphine hydrochloride

Inducing vomiting (as a mixed injection with Novadral), heroin, opiate addiction.

Aquocobalamin acetate (Vit. 12a)

Immediate treatment of hydrocyanic acid poisoning

Atropine sulfate

Acetylcholinesterase inhibitor (alkyl phosphate, carbamate poisoning)

Bentonite

Herbicides of the bipyridylium group (50 g suspended in 500 ml NaCl 0.9% p.o.)

Berlin blue (ferric hexacyanoferrate(II))

Thallium poisoning (3 g p.o., exchanges cations for Tl at the surface)

Bolus alba

Adsorbent for basic substances (alkaloids)

Calcium edetate sodium

Lead, chromium, cobalt, vanadium, zinc, cadmium, radioactive metals

Calcium salts (gluconate, lactate)

Fluorides, oxalates, allergies (primrose, thymol, Hg compounds), also p.o.

Calcium trisodium DTPA

Lead

Desferrioxamine mesylate

Iron

Digitalis antitoxin (Fab antibody)

Digitalis intoxication

Dimaval (DMPS)

Chronic poisoning with organ. and inorgan. Mercury compounds, lead compounds, arsenic, copper

4-DMAP (4-dimethylamino-phenol)

Hydrocyanic acid, cyanides

DTPA-calcium-trinatrium salt

Lead

Defoamers (Sab simplex, Lefax)

After ingestion of foaming agents (detergents, dishwashing liquids, etc.) 5 tsp Sab simplex, children 1 tsp

Acetic acid

Caustic burns (internal, diluted), lung irritation by ammonia (inhalation)

Ethanol (95%)

Methanol (adjust blood level to 1 per mille), ethylene glycol, low molecular weight glycols

Flumazenil (Anexate)

Benzodiazepines

Folic acid (Folsan)

Methanol

Folinic acid (Leucovorin)

MTX poisoning, critical decrease of leukocytes under MTX therapy

Fomepizole

Ethylene glycol poisoning; methanol poisoning

Glucose 40%

Insulin, sulfonylurea

Hexamethylenetetramine

Phosgene

Ipecacuana syrup (vomit-inducing syrup NRF).

To induce vomiting: From 5 yr, 30 ml Orpec p.o., up to 1.5 yr, 10 ml, up to 5 yr, 15 ml

Junik metered dose aerosol 100 μg.

Toxic pulmonary edema

Potassium hexacyanoferrate(II)

Copper salts: 0.6 g in water, 0.1% for gastric lavage

Potassium iodide

Thallium: 1% p.o., formation of TII, TIII3

Potassium permanganate

Alkaloids: 0.1% p.o.

Kelocyanor (Co2-EDTA)

Hydrocyanic acid

Magnesia usta (MgO)

Acid binder (50 g/500 ml water p.o.)

Macrogol 4000

see below for polyethylene glycol 400

Metalcaptase (D-penicillamine)

Heavy metal poisoning (copper, lead, mercury, zinc, gold, cobalt)

Methionine

Paracetamol

Naloxone (Naloxone, Naloselect)

Respiratory depression in opiate, analgesic, ethanol or benzodiazepine intoxication

N-acetylcysteine (Fluimucil Antidote)

Paracetamol

Sodium bicarbonate

Metaldehyde, methanol, poisoning by tricyclic antidepressants: 200 ml 5% solution p.o. or in metabolic acidosis i.v.

Sodium iodide

Thallium: gastric lavage with 1% solution

Sodium sulfate (Glauber's salt)

Laxative: 1 tbsp. in 1 glass of water, children 1 tsp. in 1 glass of water

Sodium thiosulfate

Hydrogen cyanide: CN- is converted to SCN- in the body

Obidoxime (Toxogonin)

Phosphoric acid ester

Kerosene. subliquid.

Fat-soluble toxins: Removes them by dissolving them in the gastrointestinal tract, 200 ml p.o., children 50-100 ml p.o.

Polyethylene glycol/macrogol 4000 (Laxofalk).

External poisoning by, phenol, cresol, nitrobenzene, aniline, possibly in case of hydrofluoric acid burn: washing off of the corresponding skin areas.

Physostigmine salicylate (anticholium)

Anticholinergic syndrome. Poisoning with belladonna alkaloids, spasmolytics, anti-Parkinson drugs, antihistamines, etc.

Quantalan (colestyramine)

Digitalisin intoxication, Vit. K1 antagonists

Toluidine blue

Methemoglobin builders

Trometamol (Tris-buffer, e.g. THAM)

Severe metabolic acidosis, alkalinization in barbiturate and salicylate poisoning

Vitamin K1

Vit. K1 antagonists (coumarin and derivatives)

Incoming links (3)

Acrodyny; Fomepizole; Paracetamol;

Outgoing links (1)

Poisoning;

Authors

Last updated on: 20.05.2022