Formulary Chapter 16: Emergency Treatment of Poisoning - Full Chapter
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16 |
Poisoning |
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Alcohol (Ethanol) (antidote)
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Formulary
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Atropine sulphate (Antidote)
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Formulary
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Calcium chloride (antidote)
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Formulary
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Calcium folinate (Folinic Acid) (Poisoning)
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Formulary
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Calcium gluconate (Poisoning)
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Formulary
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Calcium gluconate gel (antidote)
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Formulary
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Cyproheptadine hydrochloride (Periactin®)
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Formulary
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Dantrolene sodium (Poisoning)
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Formulary
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Diazepam (emulsion) (antidote)
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Formulary
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Flumazenil (antidote)
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Formulary
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Glucagon (GlucaGen® Hypokit) (Poisoning)
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Formulary
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Glyceryl Trinitrate
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Formulary
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Hydroxocobalamin (Cyanokit®) (antidote)
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Formulary
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Intralipid
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Formulary
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Isosorbide dinitrate
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Formulary
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Lorazepam (antidote)
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Formulary
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Macrogol '3350' (Klean-Prep®) (Poisoning)
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Formulary
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MESNA (sodium 2-mercapto-ethanesulphonate) (antidote)
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Formulary
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Octreotide (antidote)
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Formulary
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Phentolamine (antidote)
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Formulary
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Phytomenadione (vitamin K) (antidote)
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Formulary
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Pralidoxime Mesylate
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Formulary
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Procyclidine (Poisoning)
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Formulary
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Protamine Sulphate (Heparin overdose / reversal)
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Formulary
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Pyridoxine (high dose) (antidote)
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Formulary
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Sodium bicarbonate (Poisoning)
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Formulary
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Viper Venom Antivenom (antiserum / antidote)
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Formulary
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16 |
Body Temperature |
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16 |
Nerve agents |
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16 |
Pesticides |
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Activated charcoal (Actidose Aqua Advance®, Carbomix®)
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Formulary
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- Actidose Aqua Advance® – 50g in 240ml suspension
- Carbomix® - 50g powder supplied in a bottle to which
water is added to prepare a suspension
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16 |
Snake bites and animal stings |
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Adder Snakebite Antiserum (European Viper Antiverom)
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Formulary
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16 |
Convulsion |
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16 |
Removal and Elimination |
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16 |
Removal from the Gastro-intestinal tract |
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16 |
Prevention of absorption |
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16 |
Active elimination techniques |
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16 |
Specific Drugs |
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16 |
Alcohol |
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16 |
Analgesics (non-opioid) |
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Acetylcysteine 2gram in 10ml injection
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Formulary
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Paracetamol overdose
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Methionine 250mg and 500mg tablets
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Formulary
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Paracetamol overdose
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16 |
Analgesics (opioid) |
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Naloxone
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Formulary
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- 400 microgram injection – ampoules and prefilled syringes
![Green](images/TrafficLightsGreenV2.gif)
- 1.8mg/0.1ml nasal spray (single use)
- approved to offer a more convenient method of administration by non-healthcare professionals from Drug and Alcohol Services in accordance with local written protocols.
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16 |
Antidepressants |
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16 |
Antimalarials |
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16 |
Beta Blockers |
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16 |
Calcium-channel blockers |
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16 |
Hypnotics and anxiolytics |
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16 |
Iron Salts |
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Desferrioxamine
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Formulary
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- 500mg vials (for preparing injection & oral solution)
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16 |
Lithium |
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16 |
Phenothiazines and related drugs |
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16 |
Stimulants |
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16 |
Theophylline |
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16 |
Other poisons |
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16 |
Cyanides |
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Dicobalt edetate
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Formulary
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Sodium nitrite
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Formulary
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- 3% 10ml injection (30mg/ml)
unlicensed
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Sodium thiosulphate
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Formulary
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- 25% injection
unlicensed
- 50% injection
- Approved for the treatment of caliciphylaxis in patients with End Stage Renal Disease (ESRD)
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16 |
Ethylene glycol and methanol |
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Fomepizole
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Formulary
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- 100mg in 20ml injection
unlicensed
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16 |
Heavy Metals |
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Dimercaprol
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Formulary
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Penicillamine
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Formulary
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Sodium calcium edetate
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Formulary
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16 |
Noxious gases |
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16 |
CS Spray |
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16.01 |
Other items |
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.... |
Key |
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Cytotoxic Drug
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Controlled Drug
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High Cost Medicine
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NHS England |
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Homecare |
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CCG |
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Traffic Light Status Information
Status |
Description |
![Red](images/TrafficLightsRedV2.gif)
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Drugs for hospital use only. The responsibility for initiation and monitoring treatment should rest with an appropriate hospital clinician and the drug should be supplied through the hospital throughout the duration of treatment.
In some very exceptional circumstances (e.g. due to distance from the hospital, storage, supply or mobility/transport problems) it may be appropriate for the GP to be asked to prescribe a Red drug. This should be negotiated on an individual patient basis and should only be done with the GP’s prior informed agreement where the roles of the GP and hospital services are clearly defined and agreed. The GP should not feel under pressure to prescribe in these circumstances.
For all RED drugs automatically added to the formulary in response to a positive NICE TA: Prescribers need to ensure that local Trust new drug governance procedures and pharmacy processes are followed before any prescribing. |
![Amber](images/TrafficLightsAmberV2.gif)
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Drugs initiated by hospital specialist, but where continuing treatment by GPs may be appropriate under a shared care arrangement.
The specialist should send the GP a copy of the shared care agreement to sign. The GP should sign the shared care agreement, or indicate they do not want to be part of such an agreement, and return a copy back to the specialist. Shared care guidelines are available or are being developed for most of the drugs listed as Amber.
If no shared care guideline is available, the hospital specialist should provide the patient’s GP with sufficient information and support to allow treatment to be continued and managed safely in primary care. |
![Green plus](images/TrafficLightsGreenPlus.gif)
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Drugs normally recommended or initiated by a specialist (hospital or GP with an extended role https://www.rcgp.org.uk/gpwer), but can be safely maintained in primary care with very little or no monitoring required. In some cases there may be a further restriction for use outlined - these will be defined in each case. Provision of additional information, or an information leaflet, may be appropriate in some cases to facilitate continuing treatment by GPs. |
![Green](images/TrafficLightsGreenV2.gif)
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Drugs where prescribing by GPs is appropriate. Can be initiated and prescribed in all care settings, and if appropriate, discontinued without recourse to secondary care. |
![Black](images/TrafficLightsBlackV2.gif)
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NOT APPROVED: Drugs that have been considered by NTAG or the NENC ICB Medicines Subcommittee (or other approved body) and are not approved for prescribing within the North East and North Cumbria. |
![Brown](images/TrafficLightsBrownV2.gif)
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UNDER REVIEW: drugs whose current formulary status or RAG status is currently under review. |
![Not Recomended](images/TrafficLightsBlueNR.gif)
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NOT REVIEWED: Drugs that haven not been reviewed yet. This usually means that an application is in progress. These drugs are not normally considered appropriate for prescribing in the North East and North Cumbria until such time that a decision is taken on their formulary status. |
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