What Are the Different Types of Antidotes for Poisoning?

Antidote refers to drugs that can eliminate or neutralize poisons, counteract toxic effects, weaken toxic reactions, relieve or reduce symptoms of poisoning, reduce poisoning death, and treat poisoning for the purpose.

Antidote refers to drugs that can eliminate or neutralize poisons, counteract toxic effects, weaken toxic reactions, relieve or reduce symptoms of poisoning, reduce poisoning death, and treat poisoning for the purpose.

Chinese name

Antidote

Foreign name

alexipharmacons

Types of

Specific non-specific

Function

Eliminate or neutralize poisons

Overview of Antidote

Antidote refers to drugs that can eliminate or neutralize poisons, counteract toxic effects, weaken toxic reactions, relieve or reduce symptoms of poisoning, reduce poisoning death, and treat poisoning for the purpose. ^{[1] [2]}

Antidote Antidote Classification

Different types of antidote can be classified from different perspectives. According to the type of treatment poison, it can be divided into organophosphorus pesticide detoxification drugs, metal poisoning and detoxification drugs, cyanide poisoning and detoxification drugs, methemoglobinemia detoxification drugs and other detoxification drugs. class. According to the mechanism of action of antidote, antidote is divided into physical antidote, chemical antidote and physiological antagonistic antidote. At present, according to the characteristics and uses of detoxification drugs in China, they are divided into non-specific antidote and specific detoxification drug. Non-specific antidote refers to a drug that can prevent the poison from continuing to absorb and promote elimination. Such antidote has no specificity and low efficacy, and is only used as an adjuvant treatment, such as adsorbent activated carbon, laxatives, and diuretics. Specific antidote refers to a drug that can specifically fight or block poisons. It has strong specificity and good detoxification effects, such as metal complexing agents, cholinesterase reactivators, methemoglobin reducing agents, cyanide antidote, fluorine Chemical antidote and so on. ^{[1] [2]}

Application of antidote

1. Metal poisoning antidote

Dimercaptopropanol (BAL): It is a thiol chelator. It has two active thiol groups in the molecule and has a strong affinity for metals. It can capture metals that have been combined with the enzyme system in the tissue to form nontoxic complexes that are not easily dissociated. It is excreted to restore the activity of thiolase, thereby relieving the symptoms of poisoning caused by metals. Effective for acute arsenic and mercury poisoning. It is also effective against gold, antimony, chromium, bismuth, copper, cadmium, and uranium poisoning. The effects of chronic poisoning are poor.

Dimercaptosodium (DMS): This product is an antidote developed in China. The effect is roughly the same as that of BAL, and the detoxifying effect on potassium antimony tartrate is 10 times stronger, and the toxicity is less. It is used to treat antimony, lead, mercury, arsenic, and copper poisoning (the effect of treating mercury poisoning is not as good as that of sodium dimercaptosulfonate), and to prevent cadmium, cobalt, nickel poisoning, poisonous mushroom poisoning, and it can drive copper to hepatolenticular degeneration. And reduce symptoms.

Sodium dimercaptopropanesulfonate (DMPS): similar to BAL, but with better results and fewer adverse reactions. It is used for the treatment of arsenic, mercury, antimony, bismuth, copper, chromium and other poisoning, poisonous rodent poisoning, poisonous hepatitis toxic mushroom poisoning, and wormworm poisoning (NTX) pesticide poisoning.

EDTA (sodium calcium edetate, EDTA Ca-Na2): is the most commonly used aminocarboxylate chelator. This product can be combined with a variety of metals to form a stable and soluble complex, which is excreted in urine, so it is suitable for detoxification of a variety of metal poisoning. This product has special effects on inorganic lead poisoning (but not on tetraethyl lead poisoning), and has detoxifying effects on cobalt, copper, chromium, cadmium, manganese and radioactive elements (such as radium, thorium, uranium, thorium, etc.), but Strontium is not effective. Because this product is not complex with mercury, it is rarely used for detoxification of mercury poisoning. Gastrointestinal absorption is poor, and should not be administered orally.

Pentate Calcium Sodium (Promoting Detoxification, DTPA-CaNa3): The effect of this product is similar to that of calcium edetate, and it has strong stability in complexing with heavy metals. This product easily enters into the metal retention area and urges it to discharge. After intravenous injection, the urine output of pupae can be increased by 50 to 100 times. It is not easy to be absorbed orally, and can be excreted in urine from 40% 2 hours after injection. In addition to being used for the poisoning of metals such as lead, iron, zinc, cobalt, and chromium, it is also particularly effective in treating the damage to the body by radioactive elements such as thorium, thorium, strontium, yttrium, and thallium.

Pentate Zinc Trisodium: The zinc ions in this product can be replaced by radioactive metals with stronger binding force to form stable chelate compounds. This radioactive chelate compound is filtered by the glomerulus and excreted in the urine. . It can be used for the treatment of known or suspected radioactive elements such as radon, thorium or tritium to accelerate the excretion of radioactive pollutants in the body. If it is poisoned in the body other than tritium, tritium, or thorium, or unknown radioactive elements, Prussian blue and potassium iodide should be given as adjuvant therapy. This product is not effective for radioactive iodine. Chelation is most effective within the first 24 hours of radioactive element poisoning, so it should be administered in a timely manner.

Thioethylamine: It relieves the inhibition of intracellular enzyme activity of certain metals. It is mainly used for acute tetraethyl lead poisoning and has a good effect in relieving symptoms.

Deferoxamine: This product is a hydroxamic acid complexing agent. The hydroxamic acid group forms a stable, non-toxic, water-soluble iron amine and aluminum amine complex with free or protein-bound trivalent iron and aluminum, and is excreted by the urine. This product can remove iron ions in ferritin and hemosiderin, but it does not have a strong effect on removing iron ions in transferrin, and it cannot remove iron ions in hemoglobin, myosin, and cytochromes. Mainly used for acute iron poisoning and secondary hemosiderin. Chronic renal failure with encephalopathy, bone disease, and anemia caused by aluminum overload can also be applied during dialysis.

Sodium diethyldithiocarbamate: This product is a complexing agent combined with cadmium and nickel. It has a significant effect in treating acute nickel poisoning and chronic cadmium poisoning.

Sodium sulfate: After interacting with barium, it produces insoluble barium sulfate. For soluble barium salt poisoning.

1. 2. Methemoglobinemia antidote

Methylene blue (methylene blue, methylene blue): This product is a redox agent, and its role is closely related to the amount. High concentration can directly oxidize hemoglobin to methemoglobin; at low concentration, methemoglobin can be reduced to hemoglobin. Therefore, this product is used clinically to treat nitrite, chlorate, quinones, silver nitrate, nitroglycerin, quinoneimines, aniline and nitrobenzene, formazan pesticides (insecticides, monomethylamidine Methemoglobinemia caused by poisoning. Oxidation of high concentration of this product can be used to treat cyanide poisoning.

1. 3. Cholinesterase resuscitation agent

These drugs are antidote to acute organophosphorus pesticide poisoning (AOPP). Commonly used in the country are iodophorin and chlorinate, which are all oxime compounds, so they are also called oxime reactivators. Both contain quaternary ammonium group and oxime group (= NOH). The quaternary ammonium group is a cation head. It can interact with the anion site of phosphorylated ChE (poisoning enzyme) by electrostatic attraction to push the drug closer to the poisoning enzyme and make the oxime group site. Close to phosphoryl. The oxime group and the poisonous enzyme have a strong affinity for the phosphorus atom, and combine to form an oxime-toxicase resurrection (intermediate complex). Then, the phosphoryl group is shed from the poisoning enzyme to form phosphoryl oxime, so ChE is released and the activity of hydrolyzing ACh is restored.

1. Anticholinergic drugs

Anticholinergic drugs mainly act on the body's cholinergic receptors (ChR). It can compete with acetylcholine (ACh) for ChR and counteract the effects of ACh, thus showing various effects of cholinergic nerve block. Therefore, these drugs are also called cholinergic blockers. Commonly used are: atropine (peripheral anticholinergic drugs), scopolamine central anticholinergic drugs), penehyclidine hydrochloride (new anticholinergic drugs), etc. When used as an antidote, it is mainly used to treat organophosphorus (including organophosphorus pesticides and military neurotoxic agents) and carbamate pesticide poisoning. Treatment of gastrointestinal poisonous mushrooms (such as flytraps) poisoning. Treatment of Chinese medicine aconitosis. Treatment of arrhythmia caused by antimony poisoning and bradycardia caused by calcium channel blockers.

1. 5. Cyanide poisoning and antidote

Cyanide ions are easily combined with ferric iron in the body, and combined with thiocyanase to form thiocyanate with low toxicity and excreted from the urine. Therefore, the combined application of methemoglobin forming agent and sulfur supply agent can achieve detoxification. the goal of.

Methaemoglobin-forming agents: Nitrite is an isoester, and is used for cyanide poisoning first aid (an emergency measure before intravenous sodium nitrite) and angina pectoris. Sodium nitrite, for cyanide poisoning and hydrogen sulfide poisoning. This product must be applied in the early stages of poisoning. The earlier the application, the better the effect. 4-dimethylaminophenol (4-DMAP), used for first aid for cyanide poisoning. It has the advantages of strong effect, rapid effect, good stability, and small adverse reactions. The simultaneous application of nitrites is strictly prohibited.

Sulfur donating agent: sodium thiosulfate, which is one of the antidote for cyanide poisoning (combined with methemoglobin forming agent for cyanide excess poisoning), and can be free (or methemoglobin-bound) in the body with the participation of enzymes The combination of cyanide ions makes it a non-toxic thiocyanate which is excreted and detoxified. Due to the slow detoxification of this product, you must first use fast-acting sodium nitrite, isoamyl nitrite or methylene blue. In addition, sodium thiosulfate can also be used for the treatment of antihypertensive drugs such as sodium nitroprusside poisoning; soluble barium salts (such as barium nitrate) poisoning; treatment of metal poisoning such as arsenic, mercury, bismuth, lead (but dimercaptopropanols and Edetate).

1. 6.Organic fluoride poisoning antidote

Acetamide (Jieflun): This product is an antidote for poisoning by organofluorine compounds such as fluoroacetamide (an organofluoric insecticide) and sodium fluoroacetate. It has the effect of prolonging the incubation period of poisoning, reducing the symptoms or stopping the symptoms. Its detoxification mechanism may be due to the similar chemical structure of this product to fluoroacetamide, so it can compete with certain enzymes (such as amidase) to prevent it from producing fluoroacetic acid, thereby eliminating the toxic effect of fluoroacetic acid on the body's tricarboxylic acid cycle.

1. 7. Central nerve inhibitor antidote

Flumazenil: This product is a benzodiazepine (BZD) poisoning specific antidote. It is a BZD receptor-specific antagonist that can compete with BZD drugs for receptor binding sites, thereby reversing or reducing its central inhibitory effect. Ineffective against alcohol and opioid poisoning.

Naloxone: Its chemical structure is similar to that of morphine, but it has a greater affinity for opiate receptors than morphine. It can prevent morphine-like substances from binding to opiate receptors. It is an antidote to opioids, and it also increases respiratory depression due to acute poisoning. The person's breathing frequency, and can counter the sedative effect and increase blood pressure and other advantages. For the treatment of opioids and other narcotic analgesics (such as pethidine, alfalodine, methadone, fentanyl, dihydroetorphine, etoniqin, etc.) poisoning; treatment of sedative hypnotics and acute alcohol Poisoning; used to diagnose opioids and other narcotic analgesics dependence.

Allylmorphine: a morphine antagonist, mainly used for acute morphine poisoning.

1. 8. Other Antidote

Acetylcysteine: It is a specific antidote for acetaminophen poisoning. It can also be used for acute liver failure caused by drug-induced liver injury.

Calcium Folic Acid: This product is an anemia drug. As an antidote, it is mainly used: used as an antidote for folic acid antagonists (such as methotrexate, pyrimethamine or trimethoprim). Adjuvant treatment of methanol poisoning.

Sodium bicarbonate: This product is a special antidote for antidepressant poisoning. Alkaline blood can reduce the neurotoxic and cardiotoxicity caused by antidepressant drugs, play an effective role in preventing and treating seizures and various arrhythmias. It belongs to basic treatment and specific treatment, and its mechanism is unknown. It is also used for salicylic acid poisoning. The rate of salicylic acid excretion from urine depends on the pH of the urine. The excretion of pH 7.5 is 20 to 30 times that of pH 6, so sodium bicarbonate can be used. Urinates and accelerates excretion.

Vitamin B6: isoniazid antagonist. Large doses of this product are also used to rescue poisoning by poisoning rats and killing rats (by killing pyrimidine and methamphetamine).

Glucagon: can induce the release of catecholamines, is an antidote for beta receptor blocker poisoning and calcium channel blocker poisoning. The main indications are bradycardia and hypotension.

Calcium (calcium chloride, calcium gluconate): is an antidote for calcium channel blocker poisoning. Calcium administration can increase blood pressure, increase myocardial contractility, increase heart rate, and reduce or disappear AVB.

Octreotide: can reduce the effect of islet cells, and is used to treat hypoglycemia caused by excessive sulfonylurea drugs.

Vitamin K1: a specific antidote for anticoagulant rodenticide poisoning.

Prussian blue: there are two types of insoluble and soluble, the latter is commonly used as potassium salt, namely potassium ferric hexacyanoferrate, which was officially approved by the US FDA in October 2003 for the treatment of radon poisoning. Rhenium can replace potassium ions on Prussian blue to form a water-insoluble substance, which is excreted with feces. It has a certain effect on the treatment of acute and chronic radon poisoning caused by oral administration.

Metoprazole: This product is an alcohol dehydrogenase (ADH) inhibitor. It is an effective antidote for the treatment of ethylene glycol and methanol poisoning. Ethylene glycol can cause kidney failure, and methanol can cause vision impairment or blindness. Administration of this product before exposure to methanol and ethylene glycol does not appear to prevent toxicity; administration of this product after symptoms of poisoning can retard disease progression.

^{[1] [2] [3]}

Precautions for use of antidote

As a special clinical medicine, the timely and reasonable application of antidote can accelerate the removal of poisons, reduce the harm caused by poisons, reduce complications, and promote the recovery of physical functions in patients with acute poisoning. When applying antidote, it is necessary to understand the mechanism of the drug, master the dosage and indications of the drug, prevent the shortage or excess of the antidote, pay close attention to its toxic and side effects and treat it in a timely manner, so that it can play the special detoxification effect , And can minimize the secondary damage caused by antidote to poisoned patients. ^[1]