ATC Group: V03AB Antidotes

The World Health Organization's ATC classification organizes medical drugs based on therapeutic properties, chemical composition, and anatomy. It helps make essential medicines readily available globally and is widely used in the pharmaceutical industry.

Position of V03AB in the ATC hierarchy

Level Code Title
1 V Various
2 V03 All other therapeutic products
3 V03A All other therapeutic products
4 V03AB Antidotes

Group V03AB contents

Code Title
V03AB01 Ipecacuanha
V03AB02 Nalorphine
V03AB03 Edetates
V03AB04 Pralidoxime
V03AB05 Prednisolone and promethazine
V03AB06 Thiosulfate
V03AB08 Sodium nitrite
V03AB09 Dimercaprol
V03AB13 Obidoxime
V03AB14 Protamine
V03AB15 Naloxone
V03AB16 Ethanol
V03AB17 Methylthioninium chloride
V03AB18 Potassium permanganate
V03AB19 Physostigmine
V03AB20 Copper sulfate
V03AB21 Potassium iodide
V03AB22 Amyl nitrite
V03AB23 Acetylcysteine
V03AB24 Digitalis antitoxin
V03AB25 Flumazenil
V03AB26 Methionine
V03AB27 4-dimethylaminophenol
V03AB29 Cholinesterase
V03AB31 Prussian blue
V03AB32 Glutathione
V03AB33 Hydroxocobalamin
V03AB34 Fomepizole
V03AB35 Sugammadex
V03AB36 Phentolamine
V03AB37
V03AB38
V03AB54

Active ingredients in V03AB

Active Ingredient Description
Acetylcysteine

Acetylcysteine is N-acetyl derivative of cysteine. Used as a mucolytic agent to reduce the viscosity of mucous secretions.

Andexanet alfa

Andexanet alfa is a recombinant form of human FXa protein that has been modified to lack FXa enzymatic activity. Andexanet alfa is a specific reversal agent for FXa inhibitors. The predominant mechanism of action is the binding and sequestration of the FXa inhibitor. In addition, andexanet alfa has been observed to bind to, and inhibit tissue factor pathway inhibitor (TFPI). Inhibition of TFPI activity can increase tissue factor-initiated thrombin generation inducing a pro-coagulant effect.

Bentonite
Copper sulfate
Dicobalt edetate

Cyanide blocks intracellular respiration by binding to cytochrome oxidase. Dicobalt edetate forms a stable complex with the cyanide thereby acting as an antidote.

Digoxin antibodies
Dimercaprol

Dimercaprol is a chelating agent used in the treatment of acute poisoning by heavy metals.

Ethanol

Ethanol is an organic compound used in medical wipes and most commonly in antibacterial hand sanitizer gels as an antiseptic for its bactericidal and anti-fungal effects. Ethanol kills microorganisms by dissolving their membrane lipid bilayer and denaturing their proteins, and is effective against most bacteria, fungi and viruses. Ethanol also blocks conduction in peripheral nerve by decreasing the maximal values of both the sodium and potassium conductances and has a depressant action on the vasomotor-centre.

Flumazenil

Flumazenil, an imidazobenzodiazepine, is a benzodiazepine antagonist which, by competitive interaction, blocks the effects of substances acting via the benzodiazepine-receptor. Neutralisation of paradoxal reactions of benzodiazepines has been reported.

Fomepizole

Fomepizole is a competitive inhibitor of alcohol dehydrogenase. Alcohol dehydrogenase catalyzes the oxidation of ethanol to acetaldehyde and the initial steps in the metabolism of ethylene glycol and methanol to their toxic metabolites. Fomepizole is indicated as an antidote for ethylene glycol (such as antifreeze) or methanol poisoning (such as windshield washer fluid), or for use in suspected ethylene glycol or methanol ingestion, either alone or in combination with hemodialysis.

Idarucizumab

Idarucizumab is a humanized monoclonal antibody fragment (Fab) that binds to dabigatran with very high affinity, approximately 300-fold more potent than the binding affinity of dabigatran for thrombin. The idarucizumab-dabigatran complex is characterised by a rapid on-rate and extremely slow off-rate resulting in a very stable complex. Idarucizumab potently and specifically binds to dabigatran and its metabolites and neutralises their anticoagulant effect.

Ipecacuanha

Ipecacuanha root extract has been widely used in syrup form as a potent and effective emetic. Ipecacuanha powder had been used to induce sweating at the onset of influenza, and small amounts of the extract have been incorporated into cough syrups as expectorants.

Methionine
Methylthioninium chloride

In vivo, in low concentration, methylthioninium chloride speeds up the conversion of methaemoglobin to haemoglobin. Methylthioninium chloride has been observed to stain tissues selectively.

Naloxone

Naloxone hydrochloride, a semisynthetic morphine derivative (N-allyl-nor-oxymorphone), is a specific opioid antagonist that acts competitively at opioid receptors. It reveals very high affinity for the opioid receptor sites and therefore displaces both opioid agonists and partial antagonists, such as pentazocine, for example, but also nalorphine.

Obidoxime
Phentolamine

Phentolamine is a competitive non-selective α1- and α2-adrenergic receptor blocker of relatively short duration of action. It causes vasodilatation and a fall in blood pressure resulting from the blockade of both post-junctional vascular α1- and α2-adrenoceptors. It also antagonises the vasoconstrictor response to noradrenaline and adrenaline infusions.

Physostigmine

Physostigmine is a reversible inhibitor of acetylcholinesterase. As an inhibitor of acetyl-cholinesterase, physostigmine slows down the degradation of acetylcholine and acts like an indirect parasympathomimetic drug due to an increase of the acetylcholine concentration at the receptor.

Potassium iodide

Potassium iodide is indicated as a thyroid-blocking agent to prevent the uptake of radioactive iodine, for example after a nuclear accident or during a nuclear medicine investigation before administering a radioiodinated compound, which is metabolised to iodide or which contains radioiodine impurities.

Pralidoxime
Protamine

Protamine is a potent antidote for heparin. Its precise mechanism of action is unknown. However, when the strongly basic protamine combines with the strongly acid heparin, a stable salt is formed lacking in anticoagulant activity.

Prussian blue

Prussian blue insoluble binds cesium and thallium isotopes in the gastrointestinal tract after these isotopes are ingested or excreted in the bile by the liver, thereby reducing gastrointestinal reabsorption (enterohepatic circulation).

Calcium edetate
Sodium nitrite

Sodium nitrite is indicated for sequential use with sodium thiosulfate for the treatment of acute cyanide poisoning that is judged to be life-threatening. Sodium nitrite is thought to exert its therapeutic effect by reacting with hemoglobin to form methemoglobin, an oxidized form of hemoglobin incapable of oxygen transport but with high affinity for cyanide.

Succimer

Succimer is a lead chelator; it forms water soluble chelates and, consequently, increases the urinary excretion of lead.

Sugammadex

Sugammadex is a modified gamma cyclodextrin which is a Selective Relaxant Binding Agent. It forms a complex with the neuromuscular blocking agents rocuronium or vecuronium in plasma and thereby reduces the amount of neuromuscular blocking agent available to bind to nicotinic receptors in the neuromuscular junction.

Thiosulfate

Sodium thiosulfate is indicated for sequential use with sodium nitrite for the treatment of acute cyanide poisoning that is judged to be life-threatening. The primary route of endogenous cyanide detoxification is by enzymatic transulfuration to thiocyanate (SCN-), which is relatively nontoxic and readily excreted in the urine.

Sodium thiosulfate is also indicated for the prevention of ototoxicity induced by cisplatin chemotherapy. The mechanism of protection against ototoxicity may include increasing levels of endogenous antioxidants, inhibition of intracellular oxidative stress, and direct interaction between cisplatin and the thiol group in sodium thiosulfate to produce inactive platinum species.

Vitamin B12a

Hydroxocobalamin is a cyanide antidote. Its action in the treatment of cyanide poisoning is based on its ability to bind cyanide ions. Each hydroxocobalamin molecule can bind one cyanide ion by substituting it for the hydroxo ligand linked to the trivalent cobalt ion, to form cyanocobalamin, which is then excreted in the urine.

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