Antidotal therapy is useful for only a meager number of poisonous agents in which reversal of the effects of the toxin, or treatment of the toxin-induced pathophysiologic derangements, is possible. This review of selected antidotes is meant to acquaint the reader with some of the new and/or controversial uses for a few of our older agents, to introduce two new agents recently marketed, and to refresh information on antidotes not often used.
Get full access to this article
View all access options for this article.
References
1.
Centers for Disease Control: Preventing lead poisoning in young children: A statement by the Centers for Disease Control. Atlanta, GA, Centers for Disease Control, 1991, DHHS publication no. 99–2230.
2.
ShannonMGraefJLovejoyFH: Efficacy and toxicity of D-penicillamine in low-level lead poisoning. J Pediatr112:799–804, 1988.
3.
FriedheimEGrazianoJHPopovacD: Treatment of lead poisoning by 2,3-dimercaptosuccinic acid. Lancet2:1234–1236, 1978.
4.
GrazianoJHSirisESLolaconoN: 2,3-Dimercaptosuccinic acid as an antidote for lead intoxication. Clin Pharmacol Ther37:431–438, 1985.
5.
LenzRHrubyKDrumlW: 2,3-Dimercaptosuccinic acid in human arsenic poisoning. Arch Toxicol47:241–243, 1981.
6.
MortensenMEValenzuelaPM: 2,3-Dimercaptosuccinic acid (DMSA) chelation in mercury (Hg) vapor poisoning. Vet Hum Toxicol4:362, 1990 (abstr).
7.
GrazianoJHLolaconoNJMeyerP: Dose-response study of oral 2,3-dimercaptosuccinic acid in children with elevated blood lead concentrations. J Pediatr113:751–757, 1988.
8.
BertoliniJC: Hydrofluoric acid: A review of toxicity. J Emerg Med10:163–168, 1992.
9.
CaravatiEM: Acute hydrofluoric acid exposure. Am J Emerg Med6:143–150, 1987.
10.
RumackBHSpoerkeDG (eds): POISINDEX® Information System. Hydrofluoric acid management monograph. Micromedex, Inc., Denver, CO (edition expires August 31, 1992).
11.
ZaritskyALHorowitzMChernowB: Glucagon antagonism of calcium channel blocker-induced myocardial dysfunction. Crit Care Med16:246–251, 1988.
12.
KosinskiEJMalidzakGS: Glucagon and isoproterenol in reversing propranolol toxicity. Arch Intern Med132:840–843, 1973.
13.
KosinskiEJMalindzakGS: Glucagon and isoproterenol in reversing propranolol toxicity. Arch Intern Med132:840–843, 1973.
14.
RumackBHSpoerkeDG (eds): POISINDEX® Information System. Beta blocking agents management monograph. Micromedex, Inc., Denver, CO (edition expires August 31, 1992).
15.
RumackBHSpoerkeDG (eds): POISINDEX® Information System. Calcium antagonists management monograph. Micromedex, Inc., Denver, CO (edition expires August 31, 1992).
16.
MofensonHCCaraccioTRLaudanoJ: Glucagon for propranolol overdose. JAMA255:2025–2026, 1986 (editorial).
17.
CronkJD: Phenol with glucagon in cardiotherapy. N Engl J Med284:219–220, 1971 (editorial).
18.
LignianHFontaineJAskenasiR: Naloxone and alcoholic intoxication. Ann Intern Med97:455–456, 1982 (editorial).
19.
VaronJDuncanSR: Naloxone reversal of hypotension due to captopril overdose. Ann Emerg Med20:1125–1127, 1991.
20.
MillarJAStruraniARubinPC: Attenuation of the antihypertensive effect of Captopril by the opioid receptor antagonist naloxone. Clin Exp Pharmacol Physiol10:253–259, 1983.
21.
KuligKDuffyJPRumackBH: Naloxone for the treatment of clonidine overdose. JAMA247:1697, 1982.
22.
WileyJFWileyCCTorreySB: Clonidine poisoning in young children. J Pediatr116:654–658, 1990.
23.
NiemannJTGetzugTMurphyW: Reversal of Clonidine toxicity by naloxone. Ann Emerg Med15:1229–1231, 1986.
24.
BarrosSRRodriguezGJ: Naloxone as an antagonist in alcohol intoxication. Anesthesiology54:174, 1981.
25.
HigginsGLCampbellBWallaceK: Pediatric poisoning from over-the-counter imidazoline-containing products. Ann Emerg Med20:655–658, 1991.
26.
MattilaMJNuottoESeppalaT: Naloxone is not an effective antagonist of ethanol. Lancet1:775–776, 1981.
27.
FarsangCKunosG: Naloxone reverses the antihypertensive effect of clonidine. Br J Pharmacol67:161–164, 1979.
28.
FiserDHMossMMWalkerW: Critical care for clonidine poisoning in toddlers. Crit Care Med18:1124–1128, 1990.
29.
BamshadMJWassermanGS: Pediatric clonidine intoxications. Vet Hum Toxicol32:220–223, 1990.
30.
WeismanRS: Naloxone, in GoldfrankLRFlomenbaumNELewinNA (eds): Goldfrank's Toxicologic Emergencies. East Norwalk, CN, Appleton & Lange, 1990, pp 44–45.
31.
GoldfrankLWeismanRSErrickJK: A dosing nomogram for continuous infusion intravenous naloxone. Ann Emerg Med15:566–570, 1986.
32.
RumackBHSpoerkeDG (eds): POISINDEX® Information System. Opioid/opioid antagonists management monograph. Micromedex, Inc., Denver, CO (edition expires August 31, 1992).
33.
McMartinKEMartin-AmatGMakarAB: Methanol poisoning. I. The role of formic acid in the development of metabolic acidosis in the monkey and the reversal by 4-methylpyrazole. Biochem Med13:319–333, 1975.
34.
McMartinKEMartin-AmatGMakarAB: Methanol poisoning. V. Role of formate metabolism in the monkey. J Pharmacol Exp Ther201:564–572, 1977.
35.
JohlinFFortmanCNghiemD: Studies on the role of folic acid and folate dependent enzymes in human methanol poisoning. Mol Pharmacol31:557–561, 1987.
36.
JacobsenDMcMartinK: Methanol and ethylene glycol poisonings: Mechanism of toxicity, clinical course, diagnosis and treatment. Med Toxicol31:309–334, 1986.
37.
NokerPEEellsMSTephlyTR: Methanol toxicity: Treatment with folic acid and 5-formyltetrahydrofolic acid. Alcohol Clin Exp Res4:378–383, 1980.
38.
RumackBHSpoerkeDG (eds): POISINDEX® Information System. Methanol management monograph. Micromedex, Inc., Denver, CO (edition expires August 31, 1992).
39.
WoodliffHJDavisRE: Allergy to folic acid. Med J Aust1:351, 1966.
40.
WoodJDPeeskerSJ: The effect on GABA metabolism in the brain of isonicotinic acid hydrazine and pyridoxine as a function of time after administration. J Neurochem19:1527–1537, 1972.
41.
ChinLSieversMLHerrierRN: Evaluation of diazepam and pyridoxine as an antidote to isoniazid intoxication in rats and dogs. Toxicol Appl Pharmacol45:713–722, 1978.
MillerJRobinsonAPercyAK: Acute isoniazid poisoning in childhood. Am J Dis Child134:290–292, 1980.
44.
BrownCV: Acute isoniazid poisoning. Am Rev Respir Dis105:206–216, 1972.
45.
BlanchardPYaoJMcAlpineD: Isoniazid overdose in the Cambodian population of Olmsted County, Minnesota. JAMA256:3131–3133, 1986.
46.
WasonSLacouturePGLovejoyFH: Single high-dose pyridoxine treatment for isoniazid overdose. JAMA246:1102–1104, 1981.
47.
YarbroughBEWoodJP: Isoniazid overdose treated with high-dose pyridoxine. Ann Emerg Med12:303–305, 1983.
48.
RumackBHSpoerkeDG (eds): POISINDEX® Information System. Isoniazid management monograph. Micromedex, Inc., Denver, CO (edition expires August 31, 1992).
49.
HanrahanJGordonM: Mushroom poisoning: Case reports and review of therapy. JAMA251:1057–1061, 1984.
50.
ParryMFWallachR: Ethylene glycol poisoning. Am J Med57:143–150, 1974.
51.
BrownCGTrumbullDKlein-SchwartzW: Ethylene glycol poisoning. Ann Emerg Med12:501–506, 1983.
52.
RumackBHSpoerkeDG (eds): POISINDEX® Information System. Glycols management monograph. Micromedex, Inc., Denver, CO (edition expires August 31, 1992).
53.
UnnaIC: Studies of toxicity and pharmacology of vitamin B6 (2-methyl,-3-hydroxy-4,5-bis-[hydroxymethyl]-pyridoxine). J Pharmacol Exp Ther70:400–407, 1940.
54.
AlbinRLAlbersJWGreenbergHS: Acute sensory neuropathy from pyridoxine overdose. Neurology37:1729–1732, 1987.
55.
SieversMLHerriesRN: Treatment of acute isoniazid toxicity. Am J Hosp Pharm32:202–206, 1975.
56.
RumackBHSpoerkeDG (eds): POISINDEX® Information System. Cyanide management monograph. Micromedex, Inc., Denver, CO (edition expires August 31, 1992).
57.
HallAHRumackBH: Clinical toxicology of cyanide. Ann Emerg Med15:1067–1074, 1986.
58.
BerlinCM: The treatment of cyanide poisoning in children. Pediatrics46:469–493, 1970.
59.
JurkovichGJLuthermanAMcCullarK: Complications of crotalidae antivenin therapy. J Trauma28:1032–1037, 1988.
RumackBHSpoerkeDG (eds): POISINDEX® Information System. Snakes, crotalidae management monograph. Micromedex, Inc., Denver, CO (edition expires August 31, 1992).
62.
RumackBHSpoerkeDG (eds): POISINDEX® Information System. Coral snakes management monograph. Micromedex, Inc., Denver, CO (edition expires August 31, 1992).
63.
KitchensCSVan MieropLHS: Envenomation by the eastern coral snake (Micrurus fulvius fulvius). JAMA258: 1615–1618, 1987.
64.
ClarkRFWethern-KestnerSVanceMV: Clinical presentation and treatment of black widow spider envenomation: A review of 163 cases. Ann Emerg Med21:782–787, 1992.
65.
BinderLS: Acute arthropod envenomation: Incidence, clinical features and management. Med Toxicol Adverse Drug Exp4:163–173, 1989.
66.
ByrneGCPembertonPJ: Red-back spider (Latrodectus mactans hasselti) envenomation in a neonate. Med J Aust2:665–666, 1983.
67.
SutherlandSKTrincaJC: Survey of 2144 cases of red-back spider bites. Med J Aust2:620–623, 1978.
68.
KobernickM: Black widow spider bite. Am Fam Physician29:241–245, 1984.
69.
RumackBHSpoerkeDG (eds): POISINDEX® Information System. Spider-widow or hour-glass management monograph. Micromedex, Inc., Denver, CO (edition expires August 31, 1992).
70.
BrogdenRNGoaKL: Flumazenil: A reappraisal of its pharmacological properties and therapeutic efficacy as a benzodiazepine antagonist. Drugs42:1061–1089, 1991.
KlotzUKantoJ: Pharmacokinetics and clinical use of flumazenil (Ro 15–1788). Clin Pharmacokin14:1–12, 1988.
73.
Hoffman La Roche Laboratories: Mazicon package insert. Nutley, NJ, December 1991.
74.
JensenSKnudsenLKirkegaardL: Flumazenil used for antagonizing the central effects of midazolam and diazepam in outpatients. Acta Anaesthesiol Scand33:26–28, 1989.
75.
RitzRZuberMElasserS: Use of flumazenil in intoxicated patients with coma. Intens Care Med167:242–247, 1990.
76.
HojerJBaehrendtzSMatellG: Diagnostic Utility of flumazenil in coma with suspected poisoning: A double-blind, randomized controlled study. Br Med J301: 1308–1311, 1990.
77.
PrischlFDonnerAGrimmG: Value of flumazenil in benzodiazepine self-poisoning. Med Toxicol3:334–349, 1988.
78.
SpiveyWH: Flumazenil and seizures: Analysis of 43 cases. Clin Ther14:292–304, 1992.