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Bedfordshire and Luton Joint Formulary
Bedfordshire Hospitals NHS Foundation Trust
Bedfordshire, Luton and Milton Keynes ICB
Formulary Chapter: 18 - Emergency Treatment of Poisoning 
Notes:
Specialist information and advice on the treatment of poisoning is available on the Toxbase website (link below but log-in required) or from the UK National Poisons Information Service day and night on the following number:  0344 892 0111.
Links:
L&D Antidote Poster Toxbase
18 Poisoning
18 Body Temperature
18 Nerve agents
18 Pesticides
18 Snake bites and animal stings
18 Convulsion
18 Removal and Elimination
18 Removal from the Gastro-intestinal tract
18 Prevention of absorption
18 Active elimination techniques
18 Specific Drugs

Calcium folinate 300mg/30mL (Leucovorin®)
(Ampoule)

RED
Formulary

toxicity with methotrexate
toxicity with methanol and formic acid

L&D - Kept in EDC (Pharmacy emergency drug cupboard)

BHT - Kept in Primrose or via Pharmacy (Oncall Pharmacist via switchboard out of hours)

BNF BNFc SPC

Desferrioxamine 2g
(Injection)

RED
Restricted Drug Restricted

Toxicity with iron.

L&D - Kept in ED antidote cupboard and Pharmacy EDC.

BHT - Kept in Accident & Emergency

BNF BNFc SPC

Digoxin specific antibody fragments 40mg (Digifab®)
(Vial)

RED
Restricted Drug Restricted

L&D - Kept in Pharmacy EDC fridge.

BHT - contact Pharmacy (Oncall Pharmacist via switchboard out of hours)

BNF BNFc SPC

Flumazenil 500mcg/5mL

RED
Restricted Drug Restricted

Reversal of iatrogenic over-sedation with benzodiazepines.
Use with caution in patients with benzodiazepine poisoning, particularly in mixed drug overdoses; contraindicated in mixed TCA/benzodiazepine overdose.

L&D - Kept in ED, Pharmacy EDC and any wards / departments using benzodiazepines.

BHT - Kept in Accident & Emergency and any wards / departments using benzodiazepines

BNF BNFc SPC

Lipid Rescue Kit (Intralipid) 20%

RED
Restricted Drug Restricted

Local anaesthetic toxicity (e.g.lidocaine, bupivacaine). Other specific drugs in overdose (advised by NPIS / Toxbase).


L&D - Kept in theatre recovery units, ED antidote cupboard, ward 23 and Pharmacy EDC.

BHT - Kept in Accident & Emergency, Upper Theatre recovery and Delivery Suite Theatre

BNF BNFc SPC
Severe Local Anaesthetic Toxicity - AAGBI Safety Guideline

Mesna 1g in 10mL
(Ampoule)

RED
Restricted Drug Restricted

Cyclophosphamide toxicity

L&D - Kept in Pharmacy EDC.

BHT - contact Pharmacy (Oncall Pharmacist via switchboard out of hours)

BNF BNFc SPC

Octreotide 50micrograms in 1mL
(Injection)

RED
Restricted Drug Restricted

Sulphonylurea toxicity

L&D - Kept in Pharmacy EDC fridge.

BHT - contact Pharmacy (Oncall Pharmacist via switchboard out of hours)

BNF BNFc SPC

Protamine Sulphate 50mg in 5mL
(Injection)

RED
Restricted Drug Restricted

For heparin overdose.

L&D - Kept in Theatres, ITU, CCU.

BHT - Kept on AAU, Coronary Care Ward, ICU and various other wards

BNF BNFc SPC

Pyridoxine 100mg in 2mL
(Injection)

RED
Restricted Drug Restricted

Isoniazid toxicity

L&D - Kept in ED antidote cupboard.

BHT - Kept on Meadowbank ward

BNF BNFc SPC
18 Alcohol
18 Analgesics (non-opioid)
18 Analgesics (opioid)
18 Antidepressants
18 Antimalarials
18 Beta Blockers
18 Calcium-channel blockers
18 Hypnotics and anxiolytics
18 Iron Salts
18 Lithium
18 Phenothiazines and related drugs
18 Stimulants
18 Theophylline
18 Other poisons
18 Cyanides
18 Ethylene glycol and methanol
18 Heavy Metals
18 Noxious gases
18 CS Spray
Classifications
GREEN
May be initiated in any care setting
Amber SPA
Specialist to advise therapy and provide first 28 days supply, continuation in Primary Care
Amber SPIS
Specialist to initiate and stabilise medicine prior to continuation in Primary Care
SCG
To be prescribed as per Shared Care Guidance. If no SCG in place status reverts to red.
RED
Red medicines are designated as specialist only medicines which should only be prescribed by a specialist, usually within secondary care (either due to the requirement for specialist knowledge, long-term monitoring requirements, or restrictions that mean medicine supplies are only available to hospitals).
DNP
A decision has been made either locally and/or nationally not to routinely commission this preparation. Do not prescribe.
SELF
To be purchased over the counter. May be prescribed for chronic, long term conditions or on admission to hospital if essential.