Special Access: (Merck, 1-800-672- 6372) Merck Order Management Center, 1-80, will drop ship up to 2 vials. Also stocked in the Strategic National Stockpile: for mass casualties, the SNS may provide supplies for first 48 hours (coordinated by state department of health and emergency response system).Ĩ Hours: 100 mg or 13 vials (0.4 mg/mL, 20 mL each)Ģ4 hours: 200 mg or 26 vials (0.4 mg/mL, 20 mL each)Īntivenom, Crotalidae Polyvalent Immune- FAB(ovine)/ Cro-Fab®Įither antivenom product equally efficaciousĪntivenom, Crotalidae Immune- FAB 2(equine)/ Anavip®Īntivenom, Black Widow Spider/ Antivenom (Latrodectus Mactans)®Įquine base risk of allergic hypersensitivity
May require large amounts in severe cholinesterase inhibitor poisoning. Organophosphate/ carbamate insecticide poisoning and other cholinesterase inhibitors (eg, warfare agents) bradycardia induced by a variety of toxins Medical centers that might expect to receive large numbers of patients in a single incident should stock larger amounts of antidotes or have an effective and efficient drug sharing/transfer procedure in place to rapidly obtain additional antidotal supplies. The high cost and limited availability of glucagon may be the only factors precluding its future clinical acceptance.For medical centers choosing to stock antidotes, the suggested stocking level is based on the dose needed to treat a single 100 kg patient for 8 hours and for 24 hours. Glucagon-treated patients should be monitored for side effects of nausea, vomiting, hypokalemia, and hyperglycemia. The doses of glucagon required to reverse severe beta-blockade are 50 micrograms/kg iv loading dose, followed by a continuous infusion of 1-15 mg/h, titrated to patient response. Because it may bypass the beta-receptor site, glucagon can be considered as an alternative therapy for profound beta-blocker intoxications. This suggests that glucagon's mechanism of action may bypass the beta-adrenergic receptor site. These effects are unchanged by the presence of beta-receptor blocking drugs. Glucagon increases heart rate and myocardial contractility, and improves atrioventricular conduction.
Atropine and isoproterenol have been inconsistent in reversing the bradycardia and hypotension of beta-blocker overdose. Medical complications of beta-blocker overdose include hypotension, bradycardia, heart failure, impaired atrioventricular conduction, bronchospasm and, occasionally, seizures. The effects of glucagon in reversing the cardiovascular depression of profound beta-blockade, including its mechanism of action, onset and duration of action, dosage and administration, cost and availability, and side effects are reviewed. Two cases of severe beta-blocker overdose are presented that were treated successfully with glucagon therapy.
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