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ATC Group: V03AB Antidotes

Anatomical Therapeutic Chemical Classification System

Hierarchical Position

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

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
Idarucizumab
V03AB38
Andexanet alfa

Active Ingredients

Chemical substance
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. The active site serine was substituted with alanine, rendering the molecule unable to cleave and activate prothrombin, and the gamma-carboxyglutamic acid (Gla) domain was removed to eliminate the ability of the protein to assemble into the prothrombinase complex, thus removing anyanti-coagulant effects.

Bentonite
Carbon activated
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

Primary and continuous depressant of the central nervous system. It 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.

L-methionine
Methionine
Methylthioninium chloride

In vivo, in low concentration, methylthioninium chloride (also known as methylene blue) 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.

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
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.

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.

Monographs

Monograph
Type
Country
ANTICHOLIUM Injection solution
MPI, EU: SmPC
FR
ANTIZOL Solution for injection
MPI, CA: SPM
CA
BRIDION Solution for injection
MPI, EU: SmPC
CYANOKIT Powder for solution for injection
MPI, US: SPL/PLR
US
FLUMAZENIL Solution for injection or infusion
MPI, EU: SmPC
UK
METHYLTHIONINIUM CHLORIDE PROVEBLUE Solution for injection
MPI, EU: SmPC
NYXOID Nasal spray
MPI, EU: SmPC
UK
ONDEXXYA Powder for solution for infusion
MPI, EU: SmPC
UK
ORAVERSE Solution for injection
MPI, US: SPL/PLR
US
PRAXBIND Solution for injection
MPI, EU: SmPC
PRENOXAD Solution for injection/infusion
MPI, EU: SmPC
UK
PROSULF Solution for injection
MPI, EU: SmPC
UK
SEACALPHYX Solution for injection
MPI, CA: SPM
CA
SODIUM NITRITE Solutions for injection
MPI, EU: SmPC
UK