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Antidote - Wikipedia

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An antidote is a substance that can counteract a form of poisoning.^[1] The term ultimately derives from the Greek term φάρμακον ἀντίδοτον (pharmakon antidoton), "(medicine) given as a remedy". Antidotes for anticoagulants are sometimes referred to as reversal agents.^[2]

The antidotes for some particular toxins are manufactured by injecting the toxin into an animal in small doses and extracting the resulting antibodies from the host animals' blood. This results in an antivenom that can be used to counteract venom produced by certain species of snakes, spiders, and other venomous animals. Some animal venoms, especially those produced by arthropods (such as certain spiders, scorpions, and bees) are only potentially lethal when they provoke allergic reactions and induce anaphylactic shock; as such, there is no "antidote" for these venoms; however anaphylactic shock can be treated (e.g. with epinephrine).

Some other toxins have no known antidote. For example, the poison batrachotoxin – a highly poisonous steroidal alkaloid derived from various poison dart frogs, certain beetles, and birds – has no antidote, and as a result, is often fatal if it enters the human body in sufficient quantities.

Mechanical approaches

Ingested poisons are frequently treated by the oral administration of activated charcoal, which adsorbs the poison and flushes it from the digestive tract, thereby removing a large part of the toxin. Poisons which are injected into the body (such as those from bites or stings from venomous animals) are usually treated by the use of a constriction band which limits the flow of lymph and/or blood to the area, thus slowing the circulation of the poison around the body.^[3] This should not be confused with the use of a tourniquet which cuts off blood flow completely – often leading to the loss of the limb.

Techniques to identify antidotes

In early 2019, a group of researchers in Australia published the finding of a new box jellyfish venom antidote using CRISPR.^[4] The technology had been used to functionally inactivate genes in human cell lines and identify the peripheral membrane protein ATP2B1, a calcium transporting ATPase, as one host factor required for box jellyfish venom cytotoxicity.^[5]

List of antidotes

Agent	Indication
Activated charcoal with sorbitol	Used for many oral toxins
Theophylline or Caffeine	Adenosine receptor agonist poisoning
Antimuscarinic drugs (e.g. Atropine)	Organophosphate and carbamate insecticides, nerve agents, some poison mushrooms
Beta blocker	Theophylline
Calcium chloride^[6]	Calcium channel blocker toxicity,^[6] black widow spider bites
Calcium gluconate^[6]	Calcium channel blocker toxicity,^[6] hydrofluoric acid burns
Chelators such as EDTA, dimercaprol (BAL), penicillamine, and 2,3-dimercaptosuccinic acid (DMSA, succimer)	Heavy metal poisoning
Cyanide antidotes (hydroxocobalamin, amyl nitrite, sodium nitrite, or thiosulfate)	Cyanide poisoning
Cyproheptadine	Serotonin syndrome
Deferoxamine mesylate	Iron poisoning
Digoxin Immune Fab antibody (Digibind and Digifab)	Digoxin poisoning, Oleander ingestion ^[7]
Diphenhydramine hydrochloride and benztropine mesylate	Extrapyramidal reactions associated with antipsychotics
100% Ethanol or fomepizole	Ethylene glycol poisoning and methanol poisoning
Flumazenil	Benzodiazepine overdose
100% oxygen or hyperbaric oxygen therapy (HBOT)	Carbon monoxide poisoning and cyanide poisoning
Idarucizumab	Reversal of dabigatran etexilate, an anticoagulant
Insulin + Glucagon	Beta blocker poisoning and calcium channel blocker poisoning
Leucovorin	Methotrexate, trimethoprim and pyrimethamine overdose
Intralipid	Local Anesthetic toxicity
Methylene blue	Treatment of conditions that cause methemoglobinemia
Naloxone hydrochloride	Opioid overdose
N-acetylcysteine	Paracetamol (acetaminophen) poisoning
Octreotide	Oral hypoglycemic agents
Pralidoxime chloride (2-PAM)	When given with Atropine: Organophosphate insecticides, nerve agents, some poison mushrooms
Protamine sulfate	Heparin poisoning
Prussian blue	Thallium poisoning
Physostigmine sulfate	Anticholinergic poisoning
Pyridoxine	Isoniazid poisoning, ethylene glycol, accidental hydrazine exposure (E.G from Gyromitra mushrooms)
Phytomenadione (vitamin K) and fresh frozen plasma	Warfarin overdose and some (but not all) rodenticides
Sodium bicarbonate	Aspirin, TCAs with a wide QRS^{[clarification needed]}
I.V Silibinin	Amatoxin ingestion
Succimer, chemical name Dimercaptosuccinic acid (DMSA)	Lead poisoning

References

^ "antidote" at Dorland's Medical Dictionary.
^ Christos S, Naples R (2016). "Anticoagulation Reversal and Treatment Strategies in Major Bleeding: Update 2016". West J Emerg Med. 17 (3): 264–70. doi:10.5811/westjem.2016.3.29294. PMC 4899056. PMID 27330657.
^ Smith, T. A.; Figge, H. L. (October 1991). "Treatment of snakebite poisoning". American Journal of Hospital Pharmacy. 48 (10): 2190–2196. ISSN 0002-9289. PMID 1781479.
^ The-Crispr (2019-05-13). "Antidote to deadly jellyfish identified using CRISPR". The Crispr. Retrieved 2019-08-08.
^ Neely, G. Gregory; Seymour, Jamie E.; Hesselson, Daniel; Nguyen, David T.; Qiao-Ping Wang; Khuong, Thang M.; Oyston, Lisa; Littleboy, Jamie B.; Manion, John (2019-04-30). "Molecular dissection of box jellyfish venom cytotoxicity highlights an effective venom antidote". Nature Communications. 10 (1): 1655. Bibcode:2019NatCo..10.1655L. doi:10.1038/s41467-019-09681-1. ISSN 2041-1723. PMC 6491561. PMID 31040274.
^ ^a ^b ^c ^d "Calcium channel blocker poisoning". UpToDate. Retrieved 2019-07-09.
^ "Naturally Occurring Cardiac Glycoside Poisoning · California Poison Control System (CPCS)".

v t e Major chemical drug groups – based upon the Anatomical Therapeutic Chemical Classification System
gastrointestinal tract / metabolism (A)	stomach acid Antacids H₂ antagonists Proton-pump inhibitors Antiemetics Laxatives Antidiarrhoeals / Antipropulsives Anti-obesity drugs Diabetes medication Vitamins Dietary minerals
blood and blood forming organs (B)	Antithrombotics Antiplatelets Anticoagulants Thrombolytics / fibrinolytics Antihemorrhagics Platelets Coagulants Antifibrinolytics
cardiovascular system (C)	cardiac therapy / antianginals Cardiac glycosides Antiarrhythmics Cardiac stimulants Antihypertensives Diuretics Vasodilators Beta blockers Calcium channel blockers renin–angiotensin system ACE inhibitors Angiotensin II receptor antagonists Renin inhibitors Antihyperlipidemics Statins Fibrates Bile acid sequestrants
skin (D)	Emollients Cicatrizants Antipruritics Antipsoriatics Medicated dressings
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endocrine system (H)	Hypothalamic–pituitary hormones Corticosteroids Glucocorticoids Mineralocorticoids Sex hormones Thyroid hormones / Antithyroid agents
infections and infestations (J, P, QI)	Antimicrobials: Antibacterials (Antimycobacterials) Antifungals Antivirals Antiparasitics Antiprotozoals Anthelmintics Ectoparasiticides Intravenous immunoglobulin Vaccines
malignant disease (L01–L02)	Anticancer agents Antimetabolites Alkylating Spindle poisons Antineoplastic Topoisomerase inhibitors
immune disease (L03–L04)	Immunomodulators Immunostimulants Immunosuppressants
muscles, bones, and joints (M)	Anabolic steroids Anti-inflammatories Non-steroidal anti-inflammatory drugs Antirheumatics Corticosteroids Muscle relaxants Bisphosphonates
brain and nervous system (N)	Analgesics Anesthetics General Local Anorectics Anti-ADHD agents Antiaddictives Anticonvulsants Antidementia agents Antidepressants Antimigraine agents Antiparkinson agents Antipsychotics Anxiolytics Aphrodisiacs Depressants Entactogens Entheogens Euphoriants Hallucinogens Psychedelics Dissociatives Deliriants Hypnotics / Sedatives Mood stabilizers Motivation-enhancing drug Neuroprotectives Nootropics Neurotoxins Orexigenics Serenics Stimulants Wakefulness-promoting agents
respiratory system (R)	Decongestants Bronchodilators Cough medicines H₁ antagonists
sensory organs (S)	Ophthalmologicals Otologicals
other ATC (V)	Antidotes Contrast media Radiopharmaceuticals Dressings Senotherapeutics
Drugs Pharmacological classification systems ATC codes Medicine portal

Antidotes (V03AB)

Nervous
system

Alcohol intoxication	Metadoxine Thiamine
Barbiturate overdose	Bemegride Ethamivan
Benzodiazepine overdose	Cyprodenate Flumazenil
GHB overdose	Physostigmine SCH-50911
Nerve agent / Organophosphate poisoning	Atropine^# Biperiden Diazepam^# Oximes Obidoxime Pralidoxime see also: Cholinesterase
Opioid overdose	Diprenorphine Doxapram Nalmefene Nalorphine Naloxone^# Naltrexone
Reversal of neuromuscular blockade	Sugammadex

Circulatory
system

Beta blocker	Glucagon
Digoxin toxicity	Digoxin immune fab
Anticoagulants	against direct Xa inhibitors (Andexanet alfa) against heparin (Protamine^#)

Other

Arsenic poisoning	Dimercaprol^# Succimer
Cyanide poisoning	4-Dimethylaminophenol Hydroxocobalamin nitrite Amyl nitrite Sodium nitrite^# Sodium thiosulfate^#
Hydrofluoric acid	Calcium gluconate^#
Methanol / Ethylene glycol poisoning	Primary alcohols: Ethanol Fomepizole
Paracetamol toxicity (Acetaminophen)	Acetylcysteine^# Glutathione Methionine^#
Toxic metals (cadmium lead mercury thallium)	Dimercaprol^# Edetates Prussian blue^#
Other	iodine-131 Potassium iodide Methylthioninium chloride^# oxidizing agent Potassium permanganate Prednisolone/promethazine

Emetic

^#WHO-EM
^‡Withdrawn from market
Clinical trials:
- ^†Phase III
- ^§Never to phase III

v t e Toxicology
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Concepts	Acceptable daily intake Acute toxicity Bioaccumulation Biomagnification Fixed-dose procedure Lethal dose Poison Toxic capacity Toxicity class Toxin Venom
Treatments	Activated carbon Antidote Cathartic Chelation therapy Gastric lavage Hemodialysis Hemoperfusion Whole bowel irrigation
Incidents	1858 Bradford sweets poisoning 2007 pet food recalls Bhopal disaster Minamata disease Niigata Minamata disease Poisoning of Alexander Litvinenko Seveso disaster Consumption of Tide Pods Visakhapatnam gas leak 2022 Aqaba toxic gas leak List of poisonings
Related topics	Biological warfare Carcinogen Food safety Hazard symbol List of extremely hazardous substances Mutagen Occupational safety and health
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Category:

Antidotes

Hidden categories:

Mechanical approaches

Techniques to identify antidotes

List of antidotes

See also

References