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Common Specific Antidotes

Toxin

Antidote

AcetaminophenAcetaminophen

N-acetylcysteine

Anticholinergics

Physostigmine*Physostigmine*

Anticoagulants, oral factor Xa inhibitors (apixaban, edoxaban, rivaroxaban)Anticoagulants, oral factor Xa inhibitors (apixaban, edoxaban, rivaroxaban)

Andexanet alfa

Benzodiazepines

Flumazenil*Flumazenil*

Black widow spider bite

Lactrodectus antivenom

Botulism

Botulinum antitoxin

Beta-blockers

GlucagonGlucagon

IV lipid emulsion

Calcium channel blockers

Calcium

IV insulin in high doses with IV glucoseIV insulin in high doses with IV glucose

IV lipid emulsion

Carbamates

AtropineAtropine

Pralidoxime chloridePralidoxime chloride

Crotaline snake bites (United States)

Crotalinae polyvalent immune Fab (ovine)

Cyanide

HydroxocobalaminHydroxocobalamin

Cyanide antidote kit (includes amyl nitrate, sodium nitrite, and sodium thiosulfate)Cyanide antidote kit (includes amyl nitrate, sodium nitrite, and sodium thiosulfate)

DabigatranDabigatran

IdarucizumabIdarucizumab

Digitalis glycosides (eg, digoxin, digitoxin, oleander, foxglove)Digitalis glycosides (eg, digoxin, digitoxin, oleander, foxglove)

Digoxin-specific Fab fragmentsDigoxin-specific Fab fragments

Ethylene glycol

FomepizoleFomepizole

Ethanol Ethanol

Heavy metals

Chelating agents (see table Guidelines for Chelation Therapy)

Ionizing radiation

Potassium iodidePotassium iodide

Iron

DeferoxamineDeferoxamine

IsoniazidIsoniazid

Pyridoxine (vitamin B6)Pyridoxine (vitamin B6)

Methanol

FomepizoleFomepizole

Ethanol Ethanol

Methemoglobin-forming agents (eg, aniline dyes, some local anesthetics, nitrates, nitrites, phenacetin, sulfonamides)

Methylene blueMethylene blue

MethotrexateMethotrexate

Leucovorin (folinic acid) Leucovorin (folinic acid)

Glucarpidase (carboxypeptidase-G2)Glucarpidase (carboxypeptidase-G2)

Opioids

NaloxoneNaloxone

Organophosphates

AtropineAtropine

PralidoximePralidoxime

Scorpion envenomation (Centruroides sp)

Centruroides immune F(ab’)2

Sulfonylurea

OctreotideOctreotide

Thallium

Prussian blue

Tricyclic antidepressants

Sodium bicarbonateSodium bicarbonate

Unfractionated heparinUnfractionated heparin

ProtamineProtamine

Valproic acidValproic acid

L-Carnitine

WarfarinWarfarin

Vitamin K

Fresh frozen plasma

Prothrombin complex concentrate (PCC)Prothrombin complex concentrate (PCC)

* Use is controversial because toxicity may result if indications, administration, and monitoring are not appropriate. Consultation with a medical toxicologist is recommended.

There is limited evidence for the efficacy of L-carnitine as a general antidote for acute valproic acid overdose. However, L-carnitine is likely to be safe and it is reasonable to consider using it in patients with decreased level of consciousness.There is limited evidence for the efficacy of L-carnitine as a general antidote for acute valproic acid overdose. However, L-carnitine is likely to be safe and it is reasonable to consider using it in patients with decreased level of consciousness.

Fab = fractionated antibodies.