Poison/Toxin Antidote Dosage & Administration
Acetaminophen N-Acetylcysteine Oral: 140 mg/kg loading dose, then
(Paracetamol) (NAC) 70 mg/kg every 4 hrs (17 doses)
IV: 150 mg/kg over 60 min, then
50 mg/kg over 4 hrs, then 100
mg/kg over 16 hrs
Ethylene Glycol & Fomepizole, Ethanol, Fomepizole: 15 mg/kg IV loading,
Methanol Pyridoxine & then 10 mg/kg every 12 hrs
Thiamine Ethanol (if fomepizole
unavailable): 8 mL/kg of 10%
ethanol IV
Heparin Protamine Sulfate 1 mg neutralizes ~100 units of
heparin (IV, slow infusion)
Warfarin Vitamin K 2.5–10 mg oral/IV over 30 min;
(Phytonadione) severe cases may require Fresh
Frozen Plasma (FFP)
Tricyclic Sodium Bicarbonate, Sodium Bicarbonate: 1-2 mEq/kg
Antidepressants (TCAs) Benzodiazepines IV push Physostigmine (rarely
used): 1-2 mg slow IV
SSRIs (Fluoxetine, Cyproheptadine 4–12 mg orally, then 2 mg every 2
Sertraline, Paroxetine) hrs if needed
Benzodiazepines Flumazenil (Use 0.2 mg IV over 30 sec, then 0.5 mg
cautiously) every 30 sec as needed (max 5 mg)
Beta-Blockers Glucagon (+ Glucagon: 5 mg IV bolus, then 2–5
Epinephrine, Calcium mg/hr infusion
if needed)
Calcium Channel Calcium Chloride, CaCl₂: 10–20 mL IV Glucagon: 5
Blockers (CCBs) Glucagon, Insulin- mg IV push Insulin Therapy: 0.5–
Glucose 1 U/kg/hr with glucose
Cocaine Toxicity Benzodiazepines Diazepam 5–10 mg IV as needed
(Diazepam,
Lorazepam)
Acids/Alkalies Dilution with Water Drink small amounts of water/milk
(Corrosives) (No Neutralization) (Do NOT induce vomiting)
Cyanide Poisoning Hydroxocobalamin, Hydroxocobalamin: 5 g IV over
Sodium Thiosulfate, 15 min Sodium Thiosulfate: 50
Sodium Nitrite mL of 25% IV
Carbon Monoxide (CO) 100% Oxygen or 100% Oxygen via non-rebreather or
Hyperbaric Oxygen hyperbaric chamber if severe
Digoxin Toxicity Digoxin-Specific Severe cases: ~10 vials IV Mild
Antibody Fragments cases: 1–2 vials IV
(Digibind)
Hypermagnesemia Calcium Gluconate or Calcium Gluconate: 1 g IV over
Calcium Chloride 5–10 min
Hyperkalemia (High Calcium Chloride, CaCl₂: 1 g IV Sodium
Potassium Levels) Sodium Bicarbonate, Bicarbonate: 50 mEq IV
Insulin-Glucose
Iron Poisoning Deferoxamine IV: 15 mg/kg/hr (max 6 g/day);
(Chelation Therapy) continue until urine clears
Isoniazid (INH) Pyridoxine (Vitamin Seizures: 1 g IV per gram of INH
Toxicity B6) ingested
Lead Poisoning Dimercaprol (BAL), Dimercaprol: 3–5 mg/kg IM every
Calcium EDTA 4 hrs Calcium EDTA: 1000 mg/m²
IV every 24 hrs
Lithium Toxicity Sodium Polystyrene Hemodialysis for levels >4.0
Sulfonate, mEq/L
Hemodialysis if severe
Opioid Overdose Naloxone, Nalmefene Naloxone: 0.4–2 mg IV, repeat
every 2–3 min (max 10 mg)
Organophosphate Atropine, Pralidoxime Atropine: 2–5 mg IV every 5–15
Poisoning (2-PAM) min 2-PAM: 1–2 g IV over 30 min
Salicylate (Aspirin) Sodium Bicarbonate, Sodium Bicarbonate: 1–2 mEq/kg
Toxicity Hemodialysis if needed IV
Snake Bites Antivenin (Crotalidae Initial dose: 4–6 vials IV, repeat as
(Neurotoxic/Viper Polyvalent, etc.) needed
Bites)
Theophylline Overdose Beta-Blockers Esmolol (for tachycardia): 25–50
(Esmolol), Activated mcg/kg/min IV
Charcoal
Cannabis (Rare Supportive care Symptomatic treatment
Toxicity) (Rimonabant
withdrawn)
Methemoglobinemia Methylene Blue IV: 1–2 mg/kg over 5 min, repeat if
(e.g., Nitrates, Dapsone, needed
Benzocaine)
Arsenic Poisoning Dimercaprol (BAL) or Dimercaprol: 3–5 mg/kg IM every
Succimer (DMSA) 4 hrs Succimer: 10 mg/kg oral
every 8 hrs
Thallium Poisoning Prussian Blue Oral: 250 mg/kg/day in 3 divided
doses
Fluoride Toxicity Calcium Gluconate Oral gel or rinse: 2.5% calcium
gluconate IV: 10 mL of 10%
solution slowly
Sulfonylurea Overdose Octreotide & Dextrose Octreotide: 50–100 mcg SC every
(e.g., Glipizide, 6–12 hrs Dextrose: Maintain
Glyburide) euglycemia
Ricin Poisoning Supportive Care No specific antidote; aggressive
hydration, ventilation
Rattlesnake/Coral Crotalidae Polyvalent Initial: 4–6 vials IV, additional
Snake Bites Immune Fab (CroFab) doses if needed
Black Widow Spider Antivenom 1 vial IV; supportive care (opioids,
Bites (Latrodectus mactans) benzodiazepines)
Methotrexate Toxicity Leucovorin (Folinic Leucovorin: 10 mg/m² IV every 6
Acid), Glucarpidase hrs Glucarpidase: 50 U/kg IV for
(severe cases) renal failure
