13

Antidotes in Drug Poisoning

N-acetyl cysteine 140 mg / kg followed by 70 mg / kg every
4 hours for 68 hours (17 doses) as oral solution.
Chlorpromazine 1 mg / kg IM or IV.
Pilocarpine 2-4 mg orally or 0.25-0.5 mg IM. Physostigmine
1-2 mg IM every 30 min.
Physostigmine 0.5-2.0 mg IM every 30 min. Neostigmine is
ineffective because it does not enter the CNS.
Flumazenil IV in incremental doses of 0.1, 0.2, 0.3, 0.5 mg at
1-min intervals until desired effect is achieved.
100% oxygen inhalation or hyperbaric oxygen therapy.
i. Amyl nitrite (vaporal) 0.3 ml inhalation for 15-30 sec after
every min. ii
Sodium nitrate 3% solution, 0.33ml / kg
(max 10 ml) slowly IV.
iii. Sodium thiosulphate 1.65 ml / kg 25% solution (max 50 ml)
at a rate of 2.5-5.0 ml per min IV.
Ethanol 10 ml/kg 10% solution IV or 1 ml/kg of 95% by month.
Maintenance dose is 1.5 ml/kg/hr 10% solution IV or 3 ml/kg/hr
10% solution IV during hemodialysis.
i. British anti-lewisite (BAL) 12-24 mg/kg/day in 6 divided
doses IM (BAL or dimercaprol 100 mg/ml; 3 ml amp).
ii. ETDA (calcium disodium ethylene diamine tetra acetic acid)
50-75 mg / kg / day in 4 div doses IM or IV as 0.2-0.4%
solution (200 mg / ml ampoule).
iii. d-Penicillamine 20-40 mg / kg per day orally for 5 days.
iv. Oral thiamine and dimercapto succinic acid (DMSA) is
useful.
2.0 mg protamine sulfate for 100 units heparin as 1% solution
IV (10 mg / ml ampoule).
Deferoxamine 15 mg / kg / hr IV infusion. Therapy needed for
12-36 hours till urine color becomes normal (desferal 500 mg /
vial).
Pyridoxine 1.0mg IV for every 1.0 mg of isoniazid upto a
maximum of 500 mg if amount of isoniazid ingested is
umknown.
Methylene blue 1-2 mg/kg/hr IV 1% solution. May be repeated
after 4 hours (10 mg/ml ampoule) Maximum dose is 7 mg/kg.
Ethyl alcohol (ethanol) 0.75-1.0 ml/kg IV followed by 0.5 ml/kg
every hourly IV as 5% solution in sodium bicarbonate.
Alternatively it can be given as 3-4 ounces of whisky (45%
alcohol) every 4 hourly for 1-3 days in adults (Ing ethanol 2 ml
ampoule).
1. Acetaminophen (paracetamol)
Toxic dose: 150 mg / kg
2. Amphetamines Toxic dose: 50 mg
3. Atropine
4. Belladonna (Dhatura)
5. Benzodiazepines
6. Carbon monoxide
7. CyanideFatal dose: 200-300 mg
8. Ethylene glycol
9. Heavy Metals i.
Mercury i, ii,iii.
Arsenic i,iii.
Lead i, ii, iii, iv.
10. Heparin
11. Iron Toxic dose: 35 mg / kg
12. Isoniazid
13. Methemoglobinemia
14. Methyl alcohol
Poison
Antidote
14
Naloxone 0.1 mg / kg IV (max 2 mg) Repeat every 2-3 min till
the reversal of toxic effects or a cumulative dose of 10 mg is
reached (Ing narcan 0.4 mg / ml).
i. Atropine 0.02-0.05 mg / kg / dose IV every 15-30 min till
signs of atropinization develop. For continuous infusion
0.02-0.08 mg / kg / hour after the initial bolus.
ii. PAM or pralidoxime (2-Pyridine aldozime methiodide)
25-50 mg / kg IM or IV as 5% solution over 15-30 minutes.
The dose may be repeated after 1-2 hours and then at 10-12
hours intervals if cholinergic signs recur. For continuous
infusion 9-19 mg/kg/hour after the initial bolus of
25-50 mg / kg.
Diphenhydramine 1-2 mg / kg / IV every 30 min. (benadryl
cap 25 mg; 50 mg ; elixir 12.5 mg / 5 ml; amp 50 mg/ml; vials
10 mg / ml).
Atropine 0.01-0.02 mg / kg per dose SC every 5-10 min to
achieve full atropinisation. Glucagon 0.25-1.0 mg IM or IV
(Glucagon amp 1 mg / ml).
Vitamin K 5-10 mg IM or IV (Inj kapilin 10 mg / ml)