26 Drug Antidotes You Need to Know

Introduction
Antidotes are substances used to reverse the biological effects of poisoning. Of course, the boundary between what constitutes a “poison” from a “drug” is sometimes controversial.
For example, chemotherapy drugs are “poisonous” to the extent that they cause substantial damage to the body – even though this damage is performed with the long-term intent of curing the body of pathogenicity.
The Swiss physician, Paracelsus, is famed, of course, for saying that “everything is poison. There is poison in everything. Only the dose makes a thing not a poison”.
Poisons are also acquired from animals, such as frogs or snakes. Specific antidotes have been developed to manage these types of toxic poisoning. Some are effective, others not quite as effective.
“Venoms” are poisons administered to humans by bites or stings. The method of delivery impacts on the nomenclature used. When we say that an animal is “poisonous”, that is only true if the animal administers the poison by ways other than bites or stings. For example, eating a mushroom may have poisonous consequences, but you haven’t been injected with anything venomous. That term is limited to bites or stings.
When medicinal drugs are taken in overdose, it leads to toxic effects – what we also refer to as “poisoning”. Antidotes are used, at that time, to reverse the effects of poisoning. Poisoning is different from therapy in that, if the dose were lower, the poison may be considered a medicine but that, at higher doses, it causes nothing but toxic damage. At that point, an antidote is needed.
Below, we focus on antidotes used in the human clinical setting, as opposed to what may be used for non-human animals. Many antidotes tabulated below, however, also happen to be used in veterinary medicine.
Drug Antidotes
Here are some of the fundamental drug antidotes that you need to know.
Antidote | Drug |
---|---|
Activated charcoal | Many oral toxins |
Theophylline | Adenosine poisoning |
Beta blockers | Theophylline |
Calcium chloride | Calcium channel blockers Black widow spider bites |
Calcium gluconate | Hydrofluoric acid |
EDTA | Heavy metal poisoning |
Hydroxocobalamin Amyl nitrite Sodium nitrite Succimer | Cyanide poisoning |
Cyproheptadine | Serotonin syndrome / toxicity |
Deferoxamine | Iron poisoning |
Digoxin Immune Fab | Digoxin poisoning |
Flumazenil | Benzodiazepine overdose |
Glucagon | Beta blockers |
100% oxygen | Carbon monoxide |
Idarucizumab | Dabigatran etexilate |
Leucovorin / folinic acid | Methotrexate |
Naloxone | Opioid overdose |
N-acetylcysteine | Acetaminophen |
Octreotide | Oral hypoglycemic drugs |
Pralidoxime chloride | Organophosphates |
Protamine sulfate | Heparin |
Prussian blue | Thallium poisoning |
Physostigmine | Anticholinergics |
Pyridoxine | Isoniazid |
Phytomenadione (vit. K) | Warfarin poisoning |
Sodium bicarbonate | Aspirin, TCAs |
Succimer | Lead poisoning |
Conclusion
For the NAPLEX exam – and every other type of pharmacy licensing exam – you are expected to know what antidote treats what specific type of drug poisoning.
Poisonings are by no means rare.
They are regular and happen all-too-often in the clinical setting. As pharmacists, you are expected to know what antidote works best for the patient in any given situation – an active member of the healthcare team used to provide valuable feedback on the most optimum treatment plan for that given patient and his/her circumstances.
Of course, the table above is by no means complete, but it offers a convenient summary of some of the key antidotes that pharmacists are expected to know.
Check back to our NAPLEX blog soon for even more facts on drug antidotes and other key aspects of clinical pharmacy that you are expected to know!