Short-acting naloxone (Narcan brand no longer available in the United States), monitor closely for withdrawal symptoms and relapsing sedation Hypoventilation, hypotension, miosis, sedation, hypothermia, ileus Opioids (e.g., morphine, hydrocodone, methadone) Sodium nitrite 3%, sodium thiosulfate 25%Ĭentral nervous system depression, respiratory depression, seizures, hypotension, hypoglycemiaĭyspepsia, nausea, vomiting, diarrhea, dark stools Syncope, cyanosis, hypotension, psychosis Tachycardia, hypertension, fasciculations, gastrointestinal cramps, emesis, miosis Salivation, lacrimation, urination, diarrhea, bronchorrea, wheezing, bradycardia, vomitingĪtropine/pralidoxime (not available in the United States)īlack widow spider bites, carbamates, insecticides, nicotine Tachycardia, hyperthermia, mydriasis, warm and dry skin, urinary retention, ileus, deliriumĮcchymoses, bleeding, prolonged prothrombin and bleeding timesĬalcium channel blockers, beta blockers, digoxinīradycardia, arrhythmias, hypotension, dizziness, heart block, nausea, vomitingĬalcium chloride, glucagons (Glucagen), digoxin immune fab (Digibind)Ĭarbamates, some mushrooms, organophosphates, physostigmine, pilocarpine (Isopto Carpine), pyridostigmine Isoniazid (Nydrazid), phenylpropanolamine (no longer available in the United States),* theophylline*Ībdominal pain, nausea/vomiting, elevated aspartate transaminase level (greater than 1,000 IU per L after 24 hours), jaundice, confusion, somnolence, coma, disorientationĪntihistamines, atropine (Atreza), belladonna alkaloids, toxic mushrooms, psychoactive drugs
Phenothiazines,* tricyclic antidepressants*Ĭhloroquine* (Aralen), quinidine,* quinine* (Qualaquin)īeta blockers,* calcium channel blockers,* clonidine* (Catapres)Ĭough syrups, diphenoxylate/atropine* (Lomotil), methadone,* oxycodone* (Oxycontin)īenzocaine* (Americaine), lindane,* methyl salicylate (wintergreen oil),* podophyllum resin 25%* (Podocon), tea tree oil* Methylene chloride (paint thinner), selenious acid (gun bluing), zinc chloride (soldering fluid)Īcetonitrile (sculptured nail remover), methacrylic acid (artificial nail primer), nitromethane (artificial nail remover) Kerosene, lamp oil, mineral seal oil (furniture polish), mineral spirits (paint thinner), naphtha (lighter fluid) In many cases, routine dosing is adequate & will prevent NAC wastage.Beverage ethanol, ethylene glycol (antifreeze), methanol (windshield wiper fluid)Īcids (antirust compounds, toilet cleaners), alkalis (Clinitest tablets, drain or oven cleaner, perm relaxers), cleaning agents Never start High Risk NAC unless prompted to by the Poison Centre.Consider preparing 500 mL 3% NAC solutions (instead of 1L) as per the Patient Care Resource page.Call the Poison Centre for advice in all cases where an acetaminophen level is not available within 8 hours of ingestion.Draw an acetaminophen level and plot the level against time on the Rumack-Matthew nomogram to determine whether NAC is actually indicated.Do NOT start NAC based on a history of an acetaminophen exposure.The 10 mL vials (Hikma) are expected to be available in late January/early February of 2023. Hikma lot numbers 205211, 205212, 205213, 205214, 205215, 205216, 205262 have been granted extended expiry dates to January 2023 by Health Canada.Ī new supply of 30 mL vials (Hikma) is expected to be available for purchase in early January 2023. There remain 10,000 30mL vials of 20% NAC at CPDN. The Ontario, Manitoba & Nunavut Poison Centres has recently been made aware of a back-order of the 30 mL vials (Sandoz or Hikma suppliers) and the 10 mL vials (Hikma pharmaceutical). It is usually supplied in 10 mL or 30 mL vials. N-acetylcysteine (NAC), the antidote for acetaminophen toxicity, is supplied as a 20% solution (200 mg NAC per mL of diluent).
Antidote for tylenol for infant update#
UPDATE December 20, 2022: N-acetylcysteine (NAC) back-orderĪcetaminophen toxicity is the most common (~10% of all calls) exposure reported to our Poison Centre.
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