netFormulary Dorset NHS
The Dorset Formulary has been developed in associations with
NHS Dorset Clinical Commissioning Group
Dorset County Hospital NHS Foundation Trust
Dorset Healthcare University NHS Foundation Trust
Poole Hospital NHS Foundation Trust
Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust
 
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 Formulary Chapter 18: Emergency Treatment of Poisoning - Full Chapter
Notes:

The antidotes listed here are those recommended by the Royal College of Emergency Medicine and UK National Poisons Information Service (NPIS).  They are included in the Formulary as RED traffic light medicines.

Please see individual entries for local availability of antidotes.

In cases of poisoning it is strongly recommended that advice is sought from NPIS by telephone on 0344 892 0111 or online using Toxbase. Advice is available 24/7/365.

See the current BNF for notes on the emergency treatment of poisoning or click on the BNF icon adjacent to individual drugs for further details.

 Details...
18  Expand sub section  Poisoning
Acetylcysteine IV (Parvolex)
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Formulary
Red
See BNF for treatment graph and acetylcysteine treatment protocols for paracetamol overdose. 
   
Activated charcoal
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Red
For reduction of absorption of poisons in the gastro-intestinal system. Useful for many oral poisons (but see Toxbase or NPIS for advice on use). 
   
Atropine injection
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Red
For bradycardia and organophosphate or carbamate insecticide poisoning. 
   
Calcium chloride injection
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Red
For calcium channel blocker overdose and systemic effects of hydrofluoric acid. 
   
Calcium folinate
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Red
For methotrexate overdose or poisoning and methanol or formic acid poisoning. 
   
Calcium gluconate
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Red
Injection (by local infiltration) and gel (topically) for hydrofluoric acid burns.

RBCH: Gel kept in ED Resus 
   
Cyproheptadine (Periactin®)
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Red
Anticholinergic (antimuscarinic) antihistamine used in serotonin syndrome.

RBCH: kept in EDC and pharmacy 
   
Dantrolene IV
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Red
For malignant hyperthermia, neuroleptic malignant syndrome (NMS). Other drug related pyrexia seek NPIS advice.

RBCH: Kept in ITU and Theatres 
   
Desferrioxamine
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Red
For iron poisoning.

RBCH: kept in ED resus and Pharmacy 
   
Dicobalt edetate IV
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Red
For severe cyanide poisoning.

RBCH: kept in Emergency Drug Cupboard 
   
Digoxin specific antibody fragments (Digifab®)
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Red
For digoxin overdose - see Dorset-wide guideline. 
Link  All Dorset Hospitals Policy for Use of DigiFab
   
Ethanol (alcohol) injection
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Red
Orally or by injection for ethylene glycol (antifreeze) and methanol (methyl alcohol) poisoning as alternative to fomepizole. 
   
European Viper Venom Antivenom
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Formulary
Red
For European adder (Vipera berus) envenoming (bites).

DCH: Kept in ED Fridge & Emergency Drugs Fridge. 
   
Flumazenil
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Red
For reversal of benzodiazepines. 
   
Fomepizole
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Red
High Cost Medicine
unlicensedUnlicensed. Treatment of choice for methanol (methyl alcohol) and polyethylene glycol (antifreeze) poisoning. PbR excluded: Commissioned by CCG.

There is an agreement that DCH, RBCH and PHT will keep initial doses of fomepizole to allow time for additional doses to be sourced from other trusts - contact Pharmacy to arrange supplies

DCH: Available in Emergency Drugs Fridge.

RBCH: Kept on ITU 
   
Glucagon injection (GlucaGen® Hypokit)
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Red
For treatment of hypoglycaemia due to insulin overdose and supportive off-label (unlicensed) treatment of beta-blocker overdose. Other indications e.g. calcium channel blockers, seek NPIS advice.

Beta-blocker overdose requires large amounts of glucagon - contact Pharmacy to arrange supplies ASAP. 
   
Glucarpidase
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Red
Orphan drug

High Cost Medicine: Commissioned by NHS England for urgent treatment of methotrexate-induced renal dysfunction in accordance with policy.

Due to the cost of this antidote for methotrexate toxicity, it is not stocked at any hospital in the area. If a supply is needed it can be obtained on a named-patient basis from Clinigen Group 24 hours a day 7 days a week.
Within office hours:
Tel: 01283 494 340
Fax: 01283 494 341
Out of hours:
Email: outofhours@clinigengroup.com
Phone number: 07741 242858 
   
Hydroxocobalamin (Cyanokit®)
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Red
Can be considered for use in victims of smoke inhalation who show signs of significant cyanide poisoning.

RBCH: 1 kept in ED; obtain further supplies from PHT 
   
Macrogols (Klean-Prep® or similar)
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Red
For gut decontamination of agents not bound by activated charcoal (e.g. iron & lithium). 
   
Mesna
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Red
For cyclophosphamide toxicity.

RBCH: IV kept in Pharmacy Aseptic Unit 
   
Methylthioninium chloride injection (methylene blue)
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Formulary
Red
unlicensedUnlicensed. For treatment of methaemoglobinaemia and as a diagnostic aid for fistula detection.

RBCH: kept in ITU and Theatres 
   
Naloxone injection
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Red
For emergency treatment of opioid overdose. 
Link  RBCH Guidelines for Intravenous Naloxone Use in Suspected Opioid Overdose
   
Octreotide injection
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Red
For sulphonylurea overdose. 
   
Penicillamine (Distamine®)
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Phentolamine injection
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Red
For digital ischemia due to accidental injection of epinephrine (adrenaline) and resistant hypertension related to sympathomimetic drugs of abuse, MAOIs and clonidine. 
   
Phytomenadione (Vitamin K1)
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Formulary
Red
For reversal of warfarin and other coumarin anticoagulants (vitamin K1 antagonists). 
Link  Primary Care Management of high INR July 2017
   
Pralidoxime chloride (Protopam®)
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Red
For use as an adjunct to atropine in the treatment of poisoning by organophosphorus insecticides or nerve agents. ‘NAAS pods’ containing pralidoxime chloride can be obtained through the Ambulance Service from the National Blood Service — see NPIS or TOXBASE for list of designated centres.

RBCH is a designated regional holding site - kept in ED Resus 
   
Procyclidine injection
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Red
For dystonic reactions.

RBCH: kept in Emergency Drug Cupboard, ED resus and AMU 
   
Protamine Sulphate
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Red
For emergency reversal of heparin based anticoagulants. 
   
Pyridoxine injection
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Red
For isoniazid toxicity. 
   
Sodium bicarbonate infusion
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Red
Use for urinary alkalinisation & tricyclic antidepressant overdose & class 1a and 1c antiarrhythmic drugs. 
   
Sodium nitrite injection
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Red
For cyanide poisoning.

RBCH: kept in Emergency Drug Cupboard 
   
Sodium thiosulphate
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Red
For cyanide poisoning.

RBCH: kept in Emergency Drug Cupboard 
   
Tetanus Immunoglobulin (antidote botulism)
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Red
For treatment of tetanus infection (botulism) 
   
18.11.01  Expand sub section  Skin cleansers and antiseptics
18.11.07  Expand sub section  Preparations for promotion of wound healing
 ....
 Non Formulary Items
Dimercaprol

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Non Formulary Check Rarely Used Medicines (RUM) list for stockists if required.
 
DMPS (unithiol)

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Non Formulary Available from Poisons Unit at Guys & ST Thomas' Hospital if supply required.
 
Sodium calcium edetate

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Non Formulary Southampton is nearest centre to stock this item.
 
  
Key
note Notes
Section Title Section Title (top level)
Section Title Section Title (sub level)
First Choice Item First Choice item
Non Formulary Item Non Formulary section
Restricted Drug
Restricted Drug
Unlicensed Drug
Unlicensed
Track Changes
Display tracking information
click to search medicines.org.uk
Link to adult BNF
click to search medicines.org.uk
Link to children's BNF
click to search medicines.org.uk
Link to SPCs
Cytotoxic Drug
Cytotoxic Drug
CD
Controlled Drug
High Cost Medicine
High Cost Medicine
Cancer Drugs Fund
Cancer Drugs Fund
NHSE
NHS England
Homecare
Homecare
CCG
CCG

Traffic Light Status Information

Status Description

Green

May be initiated, stabilised and maintained in primary, secondary or tertiary care  

Amber

Amber drug - without shared care  

Amber SCG

Amber drug - with shared care guideline  

Red

For secondary or tertiary care initiation and long-term maintenance of prescribing  

Black

Not recommended  

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