NATIONAL POISONS INFORMATION SERVICE RECOMMENDATIONS FOR STOCKING BY ACUTE HOSPITALS OF ANTIDOTES AND OTHER DRUGS USED IN THE TREATMENT OF POISONING Updated - June 2006
This document lists the antidotes and other medicines that the National Poisons Information Service (NPIS) may recommend in the treatment of poisoning and provides recommendations for acute hospitals on arrangements for stocking.
It is recognised that individual NHS organisations are responsible for deciding which medicines they will stock and for the arrangements for use. This document is provided for guidance.
Indications for and appropriate methods of use of antidotes and other medications in poisoning can be found on TOXBASE, the on-line poisons information database of the NPIS (www.spib.axl.co.uk). Further advice can be obtained from the NPIS by telephone (0870 600 6266).
The document concerns antidotes and other medicines used in normal clinical practice. It does not address stocking of antidotes for mass exposures following deliberate release of toxic chemicals, which are subject to separate arrangements. Information on this is provided on TOXBASE.
List A specifies antidotes and other medicines that should be held by all hospitals with Accident and Emergency departments. These antidotes and medicines should be immediately available in all locations where poisoned patients are likely to be managed.
List B specifies antidotes and other medicines that may occasionally be required to treat poisoned patients. It is not considered necessary for all hospitals to stock these because of cost or infrequency of use, and/or because urgent treatment is not required. However, all hospitals should have arrangements in place for obtaining these antidotes when required.
List C specifies antidotes and other medicines that might occasionally be recommended in the treatment of poisoning, but where stocking arrangements are not considered essential
List D includes examples of medicines that are sometimes needed to support the management of poisoned patients and may be recommended in TOXBASE under particular circumstances. This list is not comprehensive.
NATIONAL POISONS INFORMATION SERVICE RECOMMENDATIONS FOR STOCKING BY ACUTE HOSPITALS OF ANTIDOTES AND OTHER DRUGS USED IN THE TREATMENT OF POISONING Should be held by all hospitals with acute medicine and/or A&E department. Recommended minimum amount to be held - enough to treat 2 patients for 48 hours
Activated charcoal oral suspension or powderAcetylcysteine injectionAtropine sulphate injectionCalcium folinate (calcium leucovorin) injectionCalcium gluconate gelCyproheptadine hydrochloride tabletsDantrolene sodiumDesferrioxamine mesilate (Deferoxamine mesilate) injectionDicobalt edetate injectionDigoxin specific antibody fragments (Digibind) injectionEthanol injectionFlumazenil injectionGlucagon injectionGlyceryl trinitrate injectionMacrogol ‘3350’ (Polyethylene glycol, Klean-Prep®) oral powderMesna oral and injection (hospitals using cyclophosphamide)Methionine tabletsMethylthioninium chloride (Methylene Blue) 1% injectionNaloxone injectionOctreotide injectionPhentolamine injection (alternative phenoxybenzamine)Pralidoxime mesylate injection (P2S, designated centres only)Procyclidine injection (alternative benztropine)Protamine sulphate injectionPyridoxine tabletsSodium bicarbonate 8.4% and 1.26% injectionSodium nitrite 3% injection Sodium thiosulphate 50% injectionVitamin K1 (Konakion) oral, injectionViper venom antiserum (depending on locality)
NATIONAL POISONS INFORMATION SERVICE RECOMMENDATIONS FOR STOCKING BY ACUTE HOSPITALS OF ANTIDOTES AND OTHER DRUGS USED IN THE TREATMENT OF POISONING Not expected to be held by all hospitals but local arrangements for availability should be in place
Venom antisera for non indigenous venomous speciesBotulinum antitoxin (should be available within 4 h)Dimercaprol (BAL) injectionDMPS (2,3-dimercapto-1-propanesulfonic Acid, Unithiol)DMSA (meso-2,3-dimercaptosuccinic acid, Succimer) tabletsFomepizole (4-Methylpyrazole) injectionMesna oral and injection (hospitals not using cyclophosphamide)Pralidoxime mesylate injection (P2S, non designated centres)Prussian Blue (Berlin Blue) oralSodium Calcium Edetate injection
Other antidotes. Not considered essential for stocking.
Hydroxocobalamin (Cyanokit ) injectionPenicillamine tabletsPhysostigmine
NATIONAL POISONS INFORMATION SERVICE RECOMMENDATIONS FOR STOCKING BY ACUTE HOSPITALS OF ANTIDOTES AND OTHER DRUGS USED IN THE TREATMENT OF POISONING Examples of other treatments that may be required for poisoned patients (not comprehensive)
Adrenaline injectionAluminium hydroxide or alternative antacidAminophylline injectionCalcium chloride injection (10% or 13.4%)Calcium gluconate injection (10%)Calcium polystyrene sulphonate (Calcium resonium)Chlorphenamine (Chlorpheniramine) or alternative antihistamine, injectionDexamethasone tablets and injectionDextrose injection (50%, 25% , 10%, 5%)Diazepam (oral, injection, rectal)Dobutamine injectionDomperidone injectionDopamine injectionFluorescein sodium eye dropsFresh Frozen plasmaHaloperidol (or alternative antipsychotic) injectionHydrocortisone injectionInfacol ® liquidInsulin injection Isoproterenol (isoprenaline) injectionLidocaine (Lignocaine) injectionLorazepam tablets and injectionMagnesium sulphateMannitol injectionMetoclopramide tablets and injectionMidazolam injectionNorepinephrine (noradrenaline) injectionOmeprazole tablets and injectionOndansetron injectionOndansetron tablets, injection, rectalMultivitamin injection (e.g. Pabrinex ®)Phenytoin injection Propranolol injection (alternatives metoprolol, esmolol)Ranitidine tablets, injectionSalbutamol inhaler solution, injectionSodium chloride 0.9% eye dropsTetanus antitoxinTetracaine (amethocaine) hydrochloride eye drops (or alternative local anaesthetic)Thiamine tabletsTropicamide (alternative cyclopentolate hydrochloride) eye dropsVerapamil injectionVitamin B complex tablet
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