Antidote

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". An older term in English which is now rare is atterlothe, derived from "atter" ("poison, venom, morbid fluid").[2] Antidotes for anticoagulants are sometimes referred to as reversal agents.[3]

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.

## Contents

* 1 Mechanical approaches
* 2 Techniques to identify antidotes
* 3 List of antidotes
* 4 See also
* 5 References

## 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.[4] 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.[5] 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.[6]

## 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[7] | Calcium channel blocker toxicity,[7] black widow spider bites
Calcium gluconate[7] | Calcium channel blocker toxicity,[7] 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 [8]
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

## See also

* Antitoxin
* Antivenom
* Snakebite
* Universal antidote
* Shapur ibn Sahl

## References

1. ↑ "antidote" at Dorland's Medical Dictionary .
2. ↑ "atterlothe". https://www.oed.com/dictionary/atterlothe_n?tab=meaning_and_use.
3. ↑ 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. PMID 27330657.
4. ↑ 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.
5. ↑ The-Crispr (2019-05-13). "Antidote to deadly jellyfish identified using CRISPR" (in en-US). https://the-crispr.com/antidote-to-deadly-jellyfish-identified-using-crispr/.
6. ↑ Neely, G. Gregory; Seymour, Jamie E.; Hesselson, Daniel; Nguyen, David T.; Qiao-Ping Wang; Khuong, Thang M.; Oyston, Lisa; Littleboy, Jamie B. et al. (2019-04-30). "Molecular dissection of box jellyfish venom cytotoxicity highlights an effective venom antidote" (in en). Nature Communications 10 (1): 1655. doi:10.1038/s41467-019-09681-1. ISSN 2041-1723. PMID 31040274. Bibcode: 2019NatCo..10.1655L.
7. ↑ 7.0 7.1 7.2 7.3 "Calcium channel blocker poisoning". https://www.uptodate.com/contents/calcium-channel-blocker-poisoning.
8. ↑ "Naturally Occurring Cardiac Glycoside Poisoning · California Poison Control System (CPCS)". https://calpoison.org/news/cardiac-glycoside-poisoning.

* v
* t
* e

Pharmacology: major drug groups

Gastrointestinal tract/
metabolism (A)|

* stomach acid
* Antacids
* H2 antagonists
* Proton pump inhibitors
* Antiemetics
* Laxatives
* Antidiarrhoeals/Antipropulsives
* Anti-obesity drugs
* Anti-diabetics
* 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
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Skin (D)|

* Emollients
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and joints (M)|

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Brain and
nervous system (N)|

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Respiratory
system (R)|

* Decongestants
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Sensory organs (S)|

* Ophthalmologicals
* Otologicals

Other ATC (V)|

* Antidotes
* Contrast media
* Radiopharmaceuticals
* Dressings
* Senotherapeutics

* v
* t
* e

Antidotes (V03AB)

Nervous
system|

| Nerve agent /
Organophosphate
poisoning|

* Atropine#
* Biperiden
* Diazepam#
* Oximes
* Obidoxime
* Pralidoxime
* see also: Cholinesterase

|

Barbiturate
overdose|

* Bemegride
* Ethamivan

Benzodiazepine
overdose|

* Cyprodenate
* Flumazenil

GHB overdose|

* Physostigmine
* SCH-50911

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|

* Copper sulfate
* Ipecacuanha
* Syrup of ipecac

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

* v
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Toxicology

* History of poison
* Toxinology

Fields|

* Aquatic toxicology
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Concepts|

* Acceptable daily intake
* Acute toxicity
* Bioaccumulation
* Biomagnification
* Fixed-dose procedure
* Lethal dose
* Poison
* Toxic capacity
* Toxicant
* Toxin
* Toxicity class
* 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
* List of poisonings

Related topics|

* Biological warfare
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