DRUGS & THEIR ANTIDOTES: A NURSES ULTIMATE GUIDE

What Is An Antidote?
The word antidote came from the Greek word antididonai which means given against.
Antidotes have long been used since the ancient times.
Hundreds of years ago, potions and concoctions were formulated in apothecaries to
treat poisons and stings. Nowadays, there is a wide range of antidotes made to
counteract accidental or intentional overdosage in clinical settings.
Basic knowledge about antidotes is essential for nurses especially those who are
working in acute care settings. To help you get started, here are some of the
most common drugs and their antidotes:

Acetylcysteine

Indication: Paracetamol, Carbon tetrachloride

Mode of Action: Protects against liver damage by enhancing production of glutathione
thereby increasing microcirculation and increasing blood flow.
Dosage: Initial dosage is 150mg/kg in 200 mL of 5% dextrose through slow IV
injection in a period of 15 minutes. Initial dose should be followed by 50mg/kg in 500
mL of 5% dextrose for 4 hours then 100mg/kg in 1000 mL of 5% dextrose for 16
hours.

Activated Charcoal

Indication: Most poisons

Mode of Action: Inhibits systemic absorption of toxin through its high adsorptive
capacity.
Dosage: 50 gram orally every 4 hours until it appears in the stool for adult and 10-15
gram orally every 4 hours for children until it appears in the stool.

Amyl Nitrite

Indication: Cyanide
Mode of Action: Facilitates conversion of hemoglobin to methemoglobin to inhibit
cyanides affinity to cytochrome oxidase enzymes thereby inhibiting its toxic effects.
Dosage: Ampoule contents should be inhaled for 30 seconds every minute. Use new
ampoule every three minutes.

Atropine

Indication: Organophosphates and carbamate poisoning

Mode of Action: Inhibits the action of acetylcholine at the muscarinic sites to interrupt
initial effects of organophosphate and carbamate poisoning.
Dosage: 2 mg through IV

Benzylpenicillin

Indication: Amatoxin poisoning

Mode of Action: Protects the liver by inhibiting entry of amatoxins into the hepatic
cells.
Dosage: 600mg/kg on the first day and 300mg/kg on the second and third day

Calcium Gluconate

Indication: Hydrofluoric acid, calcium channel blockers and oxalates

Mode of Action: Increases calcium concentration to overcome calcium channel
blockade in the cells and upkeep with depletion of calcium concentration in the system.
Dosage: 3grams for a 10% calcium gluconate that can be repeated every 10 to 20
minutes for a total of three to four doses

Cholestyramine

Indication: Anti-coagulants
Mode of Action: Inhibits the absorption of anti-coagulants in the system by forming
non-adsorbable complex with bile acids in the intestines.
Dosage: 4 grams orally for up to three times daily

Cyanokit (Hydroxocobalamin)

Indication: Cyanide poisoning

Mode of Action: Binds with cyanide ions to facilitate excretion into the urine.
Dosage: 5 grams through intravenous infusion for 15 minutes

Dicobalt edetate
Indication: Cyanide toxicity
Mode of Action: Forms stable ion-complexes with cyanide to facilitate its excretion in

the urine.
Dosage: 300mg through intravenous push for 1 minute followed by 50mL of 50%
dextrose. Initial dose may be repeated if inadequate and can be further followed by a
300mg dose.

Dimercaprol

Indication: Arsenic, gold and inorganic mercury poisoning

Mode of Action: Binds with heavy metals to form dimercaprol-metal complex which
can be readily excreted in the urine.
Dosage: 2.5mg 3mg per kilogram weight through deep IM every four hours for two
days then 2-4 times daily on the third day and 1-2 times daily for 10 days until
recovery.

Ethanol
Indication: Ethylene glycol and methanol poisoning
Mode of Action: Inhibits formation of toxic metabolites so the toxic alcohol ingested
can be excreted in the urine. It doesnt directly affect the presence of the toxic
metabolites that have already formed so hemodialysis is also recommended.
Dosage: Adult dosage for 5% ethanol is 2.76/mL/kg/hr either through oral or
intravenous route

Flumazenil

Indication: Benzodiazepine overdose

Mode of Action: Acts on benzodiazepine receptors to block central effects of
benzodiazepine.
Dosage: 0.2mg through IV for 30 seconds. If there is no response, 0.3mg can be given
for another 30 seconds. Additional doses at 0.5mg at 30-60 second intervals until a
total dose of 3mg is achieved.

Glucagon

Indication: Beta blockers, calcium channel blockers and hypoglycemic toxicity

Mode of Action: Increases myocardial contractility and heart rate similar to betaagonist effects. It also decreases vascular resistance to improve cardiac output.
Glucagon works on improving glucose levels by activating hepatic glycogen.
Dosage: 2-10mg through IV push and may be repeated as required for beta blocker
and calcium channel blocker toxicity. For hypoglycemic toxicity, 1-2mg through
intramuscular injection.

Methionine

Indication: Paracetamol poisoning

Mode of Action: Protects against liver and renal toxicity in cases of paracetamol
poisoning. It acts as a precursor of glutathione to replenish gluthione stores in the liver
cells.
Dosage: 2-5 grams followed by three 2.5 grams doses every 4 hours.

Naloxone

Indication: Opioid overdose

Mode of Action: A specific opioid antagonist that acts directly at opioid receptors to

inhibit its toxicity effects.

Dosage: 0.4 mg through intravenous push as initial dose which can be further repeated
every 2-3 minutes to a maximum bolus of 2 mg.

Penicillamine

Indication: Lead, copper and arsenic poisoning

Mode of Action: Binds with heavy metals to form stable water-soluble complexes that
can be excreted in the urine.
Dosage: Total of 1-2grams daily in divided doses throughout the day.

Phentolamine

Indication: Alpha-adrenergic poisoning, cocaine toxicity

Mode of Action: Blocks alpha1 adrenoreceptors to inhibit vasoconstriction and
decrease peripheral resistance thereby reducing blood pressure. For cocaine toxicity, it
acts as an alpha-blocker to reduce cocaine-induced coronary vasoconstriction thereby
resolving cocaine-induced myocardial ischemia.
Dosage: 2.5mg IV bolus and maybe repeated if necessary.

Phytomenadione (Vitamin K)

Indication: Anti-coagulant poisoning

Mode of Action: Interrupts anti-coagulants antagonistic effects on vitamin-dependent
coagulation factors thereby reducing anti-coagulant poisoning effects.
Dosage: 10-20mg orally

Pralidoxime

Indication: Organophosphorous insecticides

Mode of Action: Restores acetylcholinesterase activity by
removing phosphatecompounds in the phosphorylated acetylcholinesterase to
reestablish normal acetylcholinesterase activities.
Dosage: 30mg/kg through intravenous for five to ten minutes and may be repeated at
4-6 hour intervals.

Procyclidine

Indication: Induced dystonia caused by anti-psychotic drugs and metoclopramide

Mode of Action: Elicits anti-muscarinic actions to relieve parkinsonian symptoms
caused by antipsychotic drugs and metoclopramide
Dosage: 5-10mg through oral, IV or IM routes. Additional oral doses may be required
for 2-3 days.

Protamine sulfate

Indication: Heparin poisoning

Mode of Action: Binds with heparin to neutralize anti-coagulative effects in the
bloodstream.
Dosage: Maximum of 50mg dosage in a ten-minute period.

Prussian blue

Indication: Thallium poisoning

Mode of Action: Mobilizes intracellular thallium by absorbing thallium into the insoluble
crystal lattice of Prussian blue in the gastrointestinal tract.
Dosage: 250mg/kg per day orally in divided doses administered through a nasogastric
tube

Silibinin

Indication: Amatoxin poisoning

Mode of Action: Protects the liver by blocking entry of amatoxins into the hepatic
cells.

Dosage: 20mg/kg daily divided into 4 infusions with each infusion running on two-hour
duration

Sodium Calcium Edetate

Indication: Lead toxicity

Mode of Action: Binds with divalent and trivalent metals like lead to form water
soluble ring-compound to be readily excreted in the urine.
Dosage: 30-40 mg/kg through intravenous infusion either in 5% Dextrose or 0.9%
saline twice daily for up to 5 days.

Sodium nitrite

Indication: Cyanide/acrylonitrite
Mode of Action: Nitrites facilitate conversion of hemoglobin to methemoglobin.
Methemoglobin has higher binding affinity to cyanide which further facilitates its
excretion.
Dosage: 10mL of 3% sodium nitrite solution through IV for 5-20 minutes followed by
sodium thiosulphate

Sodium thiosulphate

Indication: Cyanide/acrylonitrite
Mode of Action: Acts as a precursor for the enzyme rhodanase which facilitates
conversion of cyanide to non-toxic thiocyanate and thereby promoting its excretion.
Dosage: 50mL of 25% sodium thiosulphate through IV for ten minutes

Starch

Indication: Iodine
Mode of Action: Converts iodine to iodide which is less harmful.
Dosage: 15gram starch in 500 mL water orally