An 

antidote is a substance that can counteract a form of poisoning. The term antidote is a Greek
word meaning “given against”. This post will help you familiarize yourself with the common antidotes
that are used in the hospital setting. The following are antidotes that should be familiarized by
the nurse to respond to this emergency situation quickly.

Antidote Indication Mode of Action

Restores depleted glutathione

Acetaminophen/ Tylenol/
acetylcysteine (Mucomyst) stores and protects against renal
Paracetamol
and hepatic failure.

Absorption of drug in the gastric

Non-specific poisons except
and intestinal tracts. Interrupts the
Activated charcoal cyanide, iron, lithium,
entero-hepatic cycle with multiple
caustics and alcohol.
dose.

albuterol inhaler, insulin &
Potassium
glucose, NaHCO3, kayexalate

Neuromuscular blockade
anticholinesterase agents
(paralytics)

atropine sulfate or Competitive inhibition of

Anticholinesterase
pralidoxime muscarinic receptors.

Not known; partial protection

against acute hepatic failure; may
displace amatoxin from protein-
Amanita phalloides (Death
Benzylpenicillin binding sites allowing increased
cap mushroom)
renal excretion; may also inhibit
penetration of amatoxin to
hepatocytes.

Rapidly complexes with fluoride

Calcium salts Fluoride ingestion
ion.

Deferoxamine acts by binding free

iron in the bloodstream and
deferoxamine Iron
enhancing its elimination in
the urine.

Binds molecules of digoxin, making

digibind them unavailable for binding at
Digoxin
digoxine immune fab their site of action on cells in the
body.

dimercapol, edetate calcium, Lead Chelation of lead ions and

disodium, endogenous metals (e.g., zinc,
 manganese, iron, copper).

A potent antagonist to
Extrapyramidal symptoms
diphenhydramine (Benadryl) acetylcholine in muscarinic
(EPS)
receptors.

Reverses the effects of

benzodiazepines by competitive
flumazenil Benzodiazepines
inhibition at the benzodiazepine
binding site on the GABAA receptor.

A competitive inhibitor of the

enzyme alcohol dehydrogenase
fomepizole Ethylene glycol found in the liver. This enzyme
plays a key role in the metabolism
of ethylene glycol and methanol.

Stimulates the formation of adenyl

cyclase causing intracellular
Beta blockers and calcium increase in cycling AMP and
glucagon
channel blockers enhanced glycogenolysis and
elevated serum glucose
concentration.

Dextrose (the monosaccharide

glucose) is used, distributed and
Glucose (Dextrose 50%) Insulin reaction stored by body tissues and is
metabolized to carbon dioxide and
water with the release of energy.

Reverses hypercoagulable state by

interacting with antithrombin III.
Used in combination with
Heparin Ergotamine
vasodilator phentolamine or
nitroprusside to prevent
local thrombosis and ischemia.

Forms cyanocobalamin, a non-toxic

Hydroxocobalamin Cyanide metabolite that is easily excreted
through the kidneys.

leucovorin calcium Fluorouracil

Methotrexate Protects the healthy cells from the

 effects of methotrexate while
allowing methotrexate to enter and
kill cancer cells.

Magnesium sulfate calcium gluconate

A “chemoprotectant” drug that

mesna Cyclophosphamide reduces the undesired effects of
certain chemotherapy drugs.

Chemical producing severe

methemoglobinemia. Reduces methemoglobin
Methylene blue
Ifosamide-induced to hemoglobin.
encephalopathy.

Prevents or reverses the effects of

opioids including
nalmefene or naloxone Opioid analgesics
respiratory depression, sedation
and hypotension.

Naloxone is believed to antagonize

opioid effects by competing for the
naloxone (Narcan) Narcotics µ, κ and σ opiate receptor sites in
the CNS, with the greatest affinity
for the µ receptor.

Anticholinesterase which causes

Neostigmine Anticholinergics accumulation of acetylcholine at
cholinergic receptor sites.

Oxidizes hemoglobin to
methemoglobin which binds the
Nitrite, sodium and
Cyanide free cyanide and can enhance
glycerytrinitrate
endothelial cyanide detoxification
by producing vasodilation.

Chelation of metal ions.

Copper, gold, lead, mercury,
Penicillamine
zinc, arsenic

Regitine produces an alpha-

phentolamine (Regitine) adrenergic block of relatively short
duration. It also has direct, but less
Dopamine marked, positive inotropic and
chronotropic effects on
cardiac muscle and vasodilator
effects on vascular smooth muscle.
 A reversible anticholinesterase
which effectively increases the
phyostigmine or NaHCO3 Tricyclic antidepressants concentration of acetylcholine at
the sites of cholinergic
transmission.

Bypasses inhibition of Vitamin K

Phytomenadione (Vitamin K.) Coumadin/Warfarin
epoxide reductase enzyme.

Protamine that is strongly basic

combines with acidic heparin
protamine sulfate Heparin forming a stable complex and
neutralizes the anticoagulant
activity of both drugs.

Isoniazid, theophylline, Reverses acute pyridoxine

monomethyl deficiency by promoting GABA
Pyridoxine hydrazine. Adjunctive synthesis. Promotes the conversion
therapy in ethylene glycol of toxic metabolite glycolic acid to
poisoning. glycine.

Neutralizes venom by binding with

circulating venom components and
Snake anti-venin Cobra bite
with locally deposited venom by
accumulating at the bite site.

Prevents convertion of ferrous to

Iron
ferric.

Cardiotoxic drug affecting

Decreases affinity of cardiotoxic
fast sodium channel
drugs to the fast sodium channel.
(TCA, cocaine)

Sodium Bicarbonate Weak acids Promotes ionization of weak acids.

Neutralization of hydrochloric acid

Chlorine gas inhalational
formed when chlorine gas reacts
poisoning
with water in the airways.

Sodium thiosulphate Cyanide Replenishes depleted thiosulphate

stores by acting as sulfur donor
necessary for the conversion of CN-
O to thiocyanate through the action
of sulfur transferase enzyme
 rhodanese.

Alcohol, Wernicke-Korsakoff
Reverses acute thiamine deficiency
Syndrome
Thiamine
Enhances detoxification of glyoxylic
Adjunctive in ethylene glycol
acid.

Chemicals causing
methemoglobinemia in Reduces methemoglobin to
Vitamin C
patients with G6PD hemoglobin.
deficiency