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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 cholinesteraseAtropine 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 vialsImmune-FAB(ovine)/ Cro-FabAntivenom, Black Widow Spider/ Black Widow SpiderAntivenom (Latrodectus 1 x 6000u vial ® envenomationMactans)BAL(Dimercaprol)/ BAL in oil 6 x 3 mL (10% in oil) Heavy Metal poisoning10%® amps Calcium channel blocker Can cause tissue necrosis ifCalcium 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 agentsCalcium Gluconate gel/Calgonate Hydrofluoric Acid dermal ® For topical burns 6 x 25 gm tubes2.5% gel burns ® Hyperammonemia fromCarnitine (L-Carnitine)/ Carnitor 7 x 1gm vials valproic acid toxicity Thiosulfate component can be 2 kits (or stock theCyanide Antidote Kit/ Taylor Cyanide poisoning used separately. See also Cyanokit® - seeCyanide Antidote Kit® Hydroxocobalamin (Cyanokit®). Hydroxocobalamin)Deferoxamine/ Desferal® Iron poisoning IM administration is discouraged. 12 x 500mg vials Digoxin poisoning; Other Consult with poison centerDigoxin Immune FAB (ovine)/ 15 vials of either cardiac glycosides (eg, regarding dosing, especially forDigibind® or DigiFab® product oleander, foxglove) cardiac glycosides than digoxin.DMSA (Succimer)/ Chemet® Heavy metal poisoning 1 x 100 capsule bottle Also stocked in the StrategicDTPA-Calcium Dirty bomb agents: National Stockpile but will need(Diethylenetriamine pentaacetate)/ Radioactive plutonium, supplies for first 48 hours. 1 x 1gm vialPentetate Calcium Trisodium americium and curium Coordinate with local Homelandinjection) Security office. Also stocked in the StrategicDTPA-Zinc (Diethylenetriamine Dirty bomb agents: National Stockpile but will needpentaacetate)/ Pentetate Zinc Radioactive plutonium, supplies for first 48 hours. 1 x 1gm vialTrisodium 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 longerEthanol 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. poisoningExpert 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