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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

Andexanet alfa (Ondexxya®)
(200 mg powder for solution for infusion)

RED
Restricted Drug Restricted

To be used in accordance with the following NICE TA(s):

Must refer to Haematology for advice.

BNF BNFc SPC
NICE TA697: Andexanet alfa for reversing anticoagulation from apixaban or rivaroxaban NICE TA1029: Andexanet alfa for reversing anticoagulation in people with intracranial haemorrhage (TERMINATED APPRAISAL)

Cyproheptadine 4mg (Periactin®)
(Tablets)

RED
Restricted Drug Restricted

For serotonin syndrome.

L&D - In EDC (Pharmacy EDC)

BHT - In Accident & Emergency

BNF BNFc SPC

Methylthioninium chloride 0.5% (Proveblue®)
((Methylene Blue) Injection)

RED
Restricted Drug Restricted

Methaemoglobinaemia.

L&D - Kept in ED antidote cupboard and ITU.

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

BNF BNFc SPC

Penicillamine 125mg (Distamine)
(Tablets)

Amber SPA
Restricted Drug Restricted

For copper poisoning and Wilson disease. (Not lead poisoning).

L&D - Kept in Pharmacy EDC.

BHT - Contact Pharmacy (Oncall via switchboward out of hours)

BNF BNFc SPC

Procyclidine 10mg in 2mL
(Injection)

RED
Formulary

Acute dystonia, dystonic reactions

L&D - Kept in ED antidote cupboard.

BHT - Kept in Accident & Emergency

BNF BNFc SPC
Non formulary items

Antivenoms for non-indigenous venomous animals

 
Non Formulary
BNF BNFc

Benzatropine

 
Non Formulary

Botulism antitoxin (antidote)

 
Non Formulary
BNF BNFc SPC

Carboxypeptidase (Glucarpidase)

 
Non Formulary

Dimercaprol

 
Non Formulary
BNF BNFc SPC

DMPS (unithiol)

 
Non Formulary
BNF BNFc

DMSA (succimer)

 
Non Formulary
BNF BNFc

Methionine

 
Non Formulary
BNF BNFc SPC

Potassium ferric hexacyanoferrate (Berlin / Prussian Blue)

 
Non Formulary
BNF BNFc SPC

Sodium calcium edetate

 
Non Formulary
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
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.