Help Avoid Snags With Antidotes

You can help ensure antidotes are available when needed.

These meds limit harm from poisoning and other toxicity.

For example, hydroxocobalamin is for cyanide poisoning...idarucizumab reverses dabigatran effects...and IV lipids treat cardiotoxicity from bupivacaine and other local anesthetics.

Time is of the essence to optimize benefits of antidotes. But many are used infrequently...so staff may be less familiar.

Use strategies to limit delays and other snags.

Know where antidotes are kept in your pharmacy...and which are also kept in patient care areas for quick access.

For instance, dantrolene should be available in perioperative areas to treat malignant hyperthermia caused by general anesthetics.

Anticipate that your pharmacy may consign high-cost, low-use antidotes, such as snake antivenin and digoxin immune Fab. If so, check policies and procedures for documentation, stocking, etc.

Treat antidotes as STAT meds. Work quickly...but take enough time to ensure you understand prep instructions.

Mistakes could have serious consequences...especially if stock of the antidote is limited or the patient is critical.

For example, starting acetylcysteine within 8 hours of acetaminophen overdose is important to reduce liver damage risk.

Use precautions to avoid other errors with antidotes...high-pressure situations tend to increase risk.

For instance, watch for look-alike/sound-alikes. Protonix can be confused for protamine for heparin reversal...or rocuronium for Romazicon, an old brand of the benzo reversal agent flumazenil.

Alert your purchaser when an antidote is used so they can order more ASAP. They'll want to keep specific amounts on hand...such as enough to treat a 100 kg patient for 8 to 24 hours.

Also let them know if any antidotes will expire soon...to ensure you have sufficient quantities of in-date product available.

Get our Inpatient Emergencies 101 technician tutorial to learn about other critical situations to stay prepared for.

Key References

  • Ann Emerg Med. 2018 Mar;71(3):314-325.e1
  • https://www.ismp.org/sites/default/files/attachments/2020-02/2020-2021%20TMSBP-%20FINAL_1.pdf (1-5-22)
  • Am J Health Syst Pharm. 2012 Feb 1;69(3):199-212
Hospital Pharmacy Technician's Letter. January 2022, No. 380122



Get unlimited access through an Enterprise license

Hospital Pharmacy Technician's Letter includes:

  • 12 issues every year, with brief articles about new meds and hot topics
  • 200+ CE courses, including the popular CE-in-the-Letter
  • Helpful, in-depth Technician Tutorials
  • Access to the entire archive

Already a subscriber? Log in

Not sold to individuals