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Antidotes: Its Mechanism and Therapeutic

Uses
Poisoning is very common in all human beings and to treat the poisoning the
antidotes are used. In this resource I’ve tried to explain that what antidotes
are and for what these are used, what is the mechanism of action of antidotes
and what the various uses of these are.

Antidotes
An antidote is an agent which counteracts a poison. In the treatment of acute
poisoning most patients require only supportive and symptomatic therapy. The active
removal of poisons from the stomach by gastric lavage or emesis induction is done
by the administration of substances like activated charcoal by mouth to reduce the
absorption.

Techniques used to promote the elimination of poisons from the body such as forced
diuresis, hemodialysis, or hemoperfusion are employed for a limited number of
poisons. There are some specific antidotes and their use in appropriate
circumstances can be life-saving. Such use does not preclude relevant supportive
and symptomatic treatment.

Mechanism of Action of Antidotes

Antidotes act by different mechanism. The mechanisms of action of antidotes are
given below:
1) Complex formation.

2) Metabolic conversion.

3) Prevention of toxic metabolite formation.

4) By changing the physio-chemical nature of toxicant.

5) Promotes return to normal function by repairing a defect or enhancing a function

that corrects the effects of poison.

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Classification of Antidotes
Depending on their action, antidotes are classified as:
1) Chemical Antidotes: Chemical antidotes are the agents which change the
chemical nature of poison. For example, sodium thiosulphate which changes toxic
cyanide to the non-toxic thiocyanate; sodium calcium edetate chelates agents used
for heavy metal poison.

2) Physiological Antidotes: Physiological antidotes acs by producing the effect

opposite to that of poison. For example, sodium nitrite converts hemoglobin into
methemoglobin in order to bind cyanide.

3) Mechanical Antidotes: Mechanical antidotes which prevent the absorption of

poison into the body. For example, activated charcoal absorbs the poison prior to
absorption across intestinal wall. Copper sulphate, magnesium sulphate and sodium
monohydrogen phosphate inactivate and precipitate the toxic material as insoluble
salts by chelation.

Therapeutic Uses
Antidotes are used in treatment of poisoning as well as in case of over dose of
drugs.

Following are the examples of antidotes which are used for treating poisoning:

Examples of Poisons and Antidotes

Poison/Drug (Antidote)

1-Paracetamol (acetaminophen) (N-acetylcysteine)

2-Anticoagulants, E.G., Warfarin (Vitamin K)

3-Opioids (Naloxone)

4-Iron (and other heavy metals) (Desferrioxamine, Deferasirox or Deferiprone)

5-Benzodiazepines (Flumazenil)

6-Ethylene Glycol (Ethanol, Fomepizole or Thiamine)

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7-Methanol (Ethanol or Fomepizole)

8-Cyanide (Amyl Nitrite, Sodium Nitrite and Sodium

Thiosulfate)

9-Organophosphates (Atropine and Pralidoxime)

10-Magnesium (Calcium Gluconate)

11-Calcium Channel Blockers

(Verapamil, Diltiazem) (Calcium Gluconate)

12-Beta-Blockers
Propranolol, Sotalol) (Calcium Gluconate and/or Glucagon)

13-Isoniazid (Pyridoxine)

14-Atropine (Physostigmine)

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