Pralidoxime, act as acetylcholinesterase reactivator, is used to treat organophosphate poisoning. It is administered intravenously with an initial dose of 1 to 2 grams over 15 to 30 minutes, followed by a continuous infusion of 0.5 to 1 gram per hour.
Atropine is used to treat organophosphate or carbamate poisoning. It acts as a muscarinic acetylcholine receptor antagonist. The initial dose is 2 to 5 milligrams IV and may be repeated every 5 to 10 minutes if necessary.
Flumazenil is a benzodiazepine receptor antagonist indicated for benzodiazepine overdose. It is given in a dose of 0.2 milligram IV and may be repeated every minute up to a maximum total dose of 3 milligrams.
Naloxone is an opioid receptor antagonist used to reverse the effects of opioid overdose, including respiratory depression and sedation. It is administered in doses of 0.4 to 2 milligrams intranasal, intramuscular, or intravenous depending on the situation. It can be repeated every 2 to 3 minutes if needed.
Physostigmine is an antidote for anticholinergic poisoning. It reverses the central effect of anticholinergic intoxication. The initial dose is 0.5 to 2 milligrams IV over 5 minutes and may be repeated every 20 to 30 minutes if required.
Glucagon is indicated for beta-blocker overdose. Glucagon activates adenylate cyclase, causing an increase in cyclic AMP. The initial dose is 1 to 5 milligrams IV followed by 2 to 5 milligrams per hour infusion as needed. It should be noted that glucagon commonly induces vomiting, and there is a lack of conclusive evidence regarding its effectiveness in beta-blocker overdose.
The cyanide kit contains sodium nitrite and sodium thiosulfate for intravenous infusion. Sodium nitrite antagonizes cyanide toxicity, while thiosulfate hastens the detoxification of cyanide. Sodium nitrite is given as 300 milligrams IV over 5 minutes. Sodium thiosulfate is given as 12.5 grams IV over 10 minutes.
Cyanokit or hydroxocobalamin is used as an antidote for cyanide poisoning. It works by binding to cyanide ions, forming cyanocobalamin (Vitamin B12) and facilitating the excretion of cyanide from the body. The recommended dose is 5 grams IV over 15 minutes.
Digoxin immune Fab or Digibind is used in cases of digoxin toxicity. It binds to digoxin, reducing its concentration and reversing its toxic effects. Acute digoxin overdose with cardiac arrest, life threatening cardiac dysrhythmia, ingested dose greater than 10 milligrams, serum digoxin level greater than 12 ng/ml, or serum potassium greater than 5.5 millimol per liter. The recommended dose is usually 10 to 20 vials IV.
Fomepizole is indicated for methanol or ethylene glycol poisoning. Fomepizole inhibits the enzymes involved in the metabolism of methanol and ethylene glycol, preventing the formation of toxic byproducts. It is administered as a loading dose of 15 milligrams per kilogram IV, followed by maintenance doses of 10 milligrams per kilogram every 12 hours for four doses.
Phytonadione or Vitamin K1 is used to reverse the anticoagulant effects of coumarin derivatives such as warfarin. It is typically administered intravenously at a dose of 5 to 10 milligrams.
Octreotide is used in cases of sulfonylurea overdose to control hypoglycemia. Octreotide prevents rebound hypoglycemia after treatment of sulfonylurea overdose with dextrose. It can be administered subcutaneously or intravenously at a dose of 50 to 100 micrograms every 8 to 12 hours.
Pyridoxine or Vitamin B6 is used as an antidote for isoniazid overdose. It prevents the development of seizures and metabolic acidosis. The recommended dose is 5 grams administered slowly via intravenous infusion.
N-acetylcysteine is used in cases of acetaminophen overdose. It replenishes depleted glutathione levels, protecting the liver from the toxic effects of acetaminophen metabolites. N-acetylcysteine is typically administered either orally or intravenously. The oral loading dose is 140 milligrams per kilogram, then 17 more doses every 4 hours of 70 milligrams per kilogram. The intravenous dosing regimen is a loading dose of 150 milligrams per kilogram over 60 minutes, followed by a maintenance dose of 50 milligrams per kilogram over 4 hours, and then 100 milligrams per kilogram over 16 hours.
Deferoxamine is indicated for iron poisoning. Its initial intravenous dose is 15 milligrams per kilogram per hour. Avoid infusion greater than 24 hours; infusion for 6 hours is usually sufficient. Cardiac monitoring is required during infusion since it may cause hypotension.