Antidote table
| Drug or poison | Antidote or reversal agent | Notes |
|---|---|---|
| Opioids (morphine, fentanyl, oxycodone) | Naloxone | Short duration: watch for returning sedation |
| Benzodiazepines (lorazepam, midazolam) | Flumazenil | Can trigger seizures in long-term users |
| Heparin | Protamine sulfate | Also partially reverses enoxaparin |
| Warfarin | Vitamin K (phytonadione) | Prothrombin complex concentrate or plasma for serious bleeding |
| Dabigatran | Idarucizumab (Praxbind) | |
| Apixaban, rivaroxaban | Andexanet alfa where available; prothrombin complex concentrate | Follow the facility's protocol |
| Digoxin | Digoxin immune fab (DigiFab) | Correct potassium and magnesium |
| Acetaminophen | Acetylcysteine | Most effective when started early after overdose |
| Magnesium sulfate | Calcium gluconate | Keep at the bedside during infusions |
| Beta blockers | Glucagon | |
| Calcium channel blockers | IV calcium; high-dose insulin in severe cases | |
| Insulin and sulfonylureas (hypoglycemia) | Dextrose; glucagon | Octreotide for sulfonylurea overdose |
| Anticholinergics (atropine, diphenhydramine overdose) | Physostigmine | Used selectively |
| Organophosphates and nerve agents | Atropine and pralidoxime | |
| Iron | Deferoxamine | |
| Methotrexate | Leucovorin (folinic acid) | |
| Tricyclic antidepressant cardiotoxicity | Sodium bicarbonate | |
| Malignant hyperthermia (succinylcholine, volatile anesthetics) | Dantrolene | |
| Rocuronium, vecuronium | Sugammadex; neostigmine with glycopyrrolate | |
| Norepinephrine or dopamine extravasation | Phentolamine (local infiltration) | |
| Local anesthetic systemic toxicity | 20% lipid emulsion | |
| Isoniazid overdose | Pyridoxine (vitamin B6) | Seizures in overdose |
| Methanol, ethylene glycol | Fomepizole | |
| Cyanide | Hydroxocobalamin | |
| Carbon monoxide | 100% oxygen (hyperbaric in some cases) | |
| Lithium | No antidote: fluids and hemodialysis |
Nursing points
- The antidote does not replace basic support: airway, breathing, circulation and calling for help come first.
- Many antidotes wear off before the drug does (naloxone, flumazenil): keep monitoring after the patient improves.
- Know where the antidote is stored for every high-alert drug you give, and keep calcium gluconate with magnesium sulfate and naloxone with opioid infusions.
- Poison control in the United States: 1-800-222-1222.
Frequently asked questions
What is the antidote for heparin?
Protamine sulfate. For warfarin, it is vitamin K (phytonadione), with prothrombin complex concentrate or plasma for serious bleeding.
What is the antidote for magnesium sulfate toxicity?
Calcium gluconate, given IV. It should be immediately available whenever a magnesium sulfate infusion is running.
What reverses an opioid overdose?
Naloxone. Because it may wear off before the opioid, the patient must be monitored and may need more than one dose.