Antidotes

Is there such a thing as a poison with an antidote, the way we’ve often seen in fictionalized accounts? That is, you ingest some substance, you start to feel unwell, I say to you “aha! you have been poisoned with (x)! I have a bottle of antidote here, and you’d better tell me the secret or I won’t give this to you!”, and then you tell me the secret, and I give you the antidote, and you drink it, and immediately feel better, and suffer no lasting health issues.

Sure, there are a number of them:

  1. naloxone (Narcan) - immediate antidote for all opiates, e.g.heroin, morphine, oxycodone, etc.

  2. flumazenil - works immediately to counter the effects of all benzodiazepine drugs, e.g. diazepam (valium), alprazolam (Xanax)

  3. physostigmine - counters so-called anticholinergic effects of many drugs. Some drugs are “pure” anticholinergics (e.g. atropine), but many other drugs simply possess some degree of anticholinergic activity (which can be very high and ‘very lethal’ in overdosage), e.g. tricyclic antidepressants such as amitriptyline (Elavil), antihistamines such as Gravol and Benadryl, and many others.

The three above are specific antidotes for the drugs listed. That is they specifically and directly oppose the action of the culprit drug.

  1. various nitrites - used as an antidote for cyanide poisoning. This is a less specific, indirect, essentially “metabolic” antidote.

Some people would call acetylcysteine (Mucomyst) an antidote for acetaminophen (Tylenol) poisoning. In my opinion, that’s not completely accurate, i.e. acetylcysteine doesn’t inhibit or oppose the effect of acetaminophen (as would a traditional antidote). Rather, acetylcysteine prevents the toxic metabolites and toxic effects of acetaminophen poisoning from developing. And, by doing so, it is a genuine lifesaver.

ETA: except for acetylcysteine, these antidotes must be given IV (well, some nitrites can be snorted, so I suppose that’s another antidote one could take on one’s own).

One can take oral naltrexone instead of IV naloxone to counteract opioids.

Of course, it may not act fast enough…

Vitamin K is an antidote for Warfarin. I don’t know if it would work in a movie-drama sort of way, though.

Atropine was issued to the public in Israel during the Gulf War incase any of Iraq’s scud missiles had nerve agent warheads.

There were hundreds of cases of atropine poisoning when people panicked and took it without needing it or injected themselves by accident (cite).

Seems that accidentally injecting atropine is not too serious.

I was told by a gulf war vet in the Army that there was a guy who slept on his protective mask case as a pillow. He forgot the atropine autoinjector was in there and accidentally injected it into his brain stem while asleep and died. So it could be serious in some cases. (You’re supposed to inject it into your upper thigh.)

Also, we weren’t issued atropine injectors in the more recent Iraq debacle. At least I wasn’t. I saw pictures of the invading force in full NBC gear, maybe they were issued injectors. Anyway, the Army was more careful with those things the second time around. I wouldn’t say they were harmless.