Antagonists

Section 8 - MEDICATION GUIDELINES

8.04 ANTAGONISTS

Flumazenil (ROMAZICON) / Antagonist

DESCRIPTION

• It is a benzodiazepine antagonist.

INDICATIONS

• Inadvertent overmedication with VERSED or VALIUM

CONTRAINDICATIONS

• Hypersensitivity to the medication, Tricyclic antidepressant overdoses.

PRECAUTIONS

• Use with caution in cases of mixed overdose, adverse reactions include arrhythmias and seizures.

DOSAGE

• Usual dosage is 0.2 mg IV over 15 seconds; wait 45 seconds, then give 0.2 mg if consciousness does not occur; may be repeated 60 second intervals prn, up to 4 additional doses-max 1 mg.
• Refer to Handtevy System for pediatric specific dosages
  • Premie - 5 y/o: 0.01 mg/kg
  • 6 years and older: 0.2 mg

Naloxone (NARCAN) / Antagonist

DESCRIPTION

• It is an effective agent that blocks the effects of both natural and synthetic narcotics. It may be helpful in coma due to alcohol ingestion.

INDICATIONS

• Narcotic and synthetic narcotic overdose, altered level of consciousness, and coma of unknown origin.

CONTRAINDICATIONS

• Hypersensitivity to the medication.

PRECAUTIONS

• May induce withdrawal. It has a half-life that is shorter than most narcotics, hence the patient may return to the overdose state.

DOSAGE

• 2 mg IVP, IM, or ET up to 10 mg AND refer to appropriate PRACTICE PARAMETER for specific dosages.
• Refer to Handtevy System for pediatric specific dosages
  • Premie - 5 y/o: 0.1 mg/kg
  • 6 years and older: 2 mg

CyanoKit® (Hydroxocobalamin)

DESCRIPTION

• CYANOKIT® Antidote is a cyanide poisoning antidote. Upon administration of CYANOKIT® Antidote, hydroxocobalamin directly binds cyanide, forming a natural form of vitamin B12, cyanocobalamin, which is excreted in the urine.

INDICATIONS

• Cyanokit contains hydroxocobalamin, an antidote indicated for the treatment of known or suspected cyanide poisoning.

CONTRAINDICATIONS

• Hypersensitivity to the medication.

PRECAUTIONS

• Most common adverse reactions (>5%) include transient chromaturia, erythema, rash, increased blood pressure, nausea, headache, and injection site reactions

DOSAGE

• The starting dose of Cyanokit for adults is 5 g, (two 2.5 g vials) administered by IV infusion over 15 minutes.
• Depending upon the severity of the poisoning and the clinical response, a second dose of 5 g may be administered by IV infusion for a total dose of 10 g.
• Refer to Handtevy System for pediatric specific dosages