ResusDoc
Drug Monographs
Textbook-depth, referenced articles on the drugs we actually reach for in the emergency department — the pharmacology behind them, the evidence under them, and the places they catch people out.
70 monographs · UK licensing · primary sources cited
Glutathione precursor — antidote in paracetamol poisoning
Acetylcysteine Acetylcysteine 200 mg/mL injection (NAC)
The same 300 mg/kg, delivered over 12 hours instead of 21, with a fifth of the anaphylactoid reactions. Standard UK care — though the product labels have not caught up.
Adsorbent — non-specific gastrointestinal decontaminant and enhancer of elimination
Activated charcoal Carbomix · Actidose-Aqua · Charcodote
The rule everybody learned — one hour, or don't bother — has been superseded for selected poisons. The 2026 international guideline replaces it with a poison-by-poison risk assessment and a window of up to six hours.
Endogenous purine nucleoside · AV nodal blocking agent
Adenosine Adenocor
A ten-second drug that is almost always given wrongly — too slowly, too distally, and with too little warning to the patient.
Endogenous catecholamine · α and β adrenoceptor agonist
Adrenaline Epinephrine · EpiPen · Jext
The most important drug in the department, and the one whose two concentrations kill people when confused.
Methylxanthine — phosphodiesterase inhibitor and adenosine receptor antagonist
Aminophylline Aminophylline 25 mg/mL injection
A narrow therapeutic index, a loading dose that must be omitted if the patient is already taking it, and a niche in resuscitation almost nobody expects.
Class III antiarrhythmic (multi-channel blocker)
Amiodarone Cordarone X
Blocks every channel it meets and damages most organs it reaches — yet remains the antiarrhythmic we give when the shocks stop working.
Recombinant modified factor Xa decoy — specific reversal agent for apixaban and rivaroxaban
Andexanet alfa Ondexxya
A decoy factor Xa that mops up apixaban and rivaroxaban. Effective, thrombogenic, expensive, and recommended by NICE for gastrointestinal bleeding only.
Antimuscarinic (competitive acetylcholine antagonist)
Atropine —
Simple to dose and easy to misuse — too small a dose slows the heart, and in the blocks that matter most it does not work at all.
Beta-1 selective adrenoceptor antagonist
Bisoprolol Cardicor · Emcor
Oral only, so never the answer to a tachycardia in front of you — but very often the drug you must decide what to do with.
Divalent cation — membrane stabilisation and calcium replacement
Calcium salts Calcium chloride 10% · Calcium gluconate 10%
Three UK ampoules, all called ten percent something, containing 2.23, 6.8 and 10 mmol of calcium. Getting the salt right matters more than getting the volume right.
First-generation antihistamine with non-specific 5-HT1A and 5-HT2 antagonism
Cyproheptadine Periactin
The only thing resembling an antidote for serotonin toxicity. It is oral, unlicensed for the purpose, absent from the emc, and a 2025 review concludes its clinical effect is probably just sedation.
Water-soluble dithiol chelator; 2,3-dimercapto-1-propanesulfonate
DMPS (Unithiol)
The chelator associated with objective recovery from mercury brain injury in one documented UK case, and which no UK company sells.
Ryanodine receptor (RyR1) antagonist — direct skeletal muscle relaxant
Dantrolene Agilus · Dantrium IV (discontinued) · Dantrium capsules
The only drug that treats malignant hyperthermia, and the only one whose UK preparation has quietly changed in a way that invalidates the number most people memorised.
Siderophore-derived hexadentate iron chelator
Desferrioxamine Desferal
The antidote to a poisoning that looks better before it gets much worse, given to a patient whose urine tells you it is working.
Cardiac glycoside · Na⁺/K⁺-ATPase inhibitor
Digoxin Lanoxin
Two hundred years old, still in the algorithm, and the only rate-control drug that works in a patient too unwell for the others.
Ovine digoxin-specific antibody fragments — antidote
Digoxin immune Fab DigiFab
The UK label divides serum digoxin by 200. The US label divides it by 100. Both are current, both are for the same product, and the difference is a factor of two in an antidote.
Non-dihydropyridine calcium channel blocker (class IV)
Diltiazem Tildiem · Adizem · Slozem
The rate-control drug UK clinicians read about in American papers and cannot give intravenously — because the IV preparation does not exist here.
Oil-based dithiol chelator; British anti-Lewisite
Dimercaprol (BAL)
The original chelator, invented to counter a chemical weapon, now largely superseded by the analogues built to fix its faults.
Synthetic catecholamine · β₁-predominant inotrope
Dobutamine —
An inotrope, not a vasopressor — and one that can lower the blood pressure of the patient you gave it to.
Endogenous catecholamine — dose-dependent dopaminergic, β₁ and α₁ agonist
Dopamine Dopamine hydrochloride concentrate
The vasopressor that taught a generation a dose-response model that turned out not to describe individual patients — and lost its first-line place to noradrenaline on arrhythmias.
Competitive substrate for alcohol dehydrogenase
Ethanol Dehydrated Alcohol (Absolute Alcohol) BP for Injection — discontinued
The original toxic alcohol antidote, dosed by the drinking history of the patient and titrated to a blood alcohol level. The UK product is discontinued and the regimen survives mainly as the fallback when fomepizole cannot be found.
Imidazole intravenous general anaesthetic — GABA-A potentiator
Etomidate Hypnomidate
The induction agent that does not drop the blood pressure, and inhibits cortisol synthesis after a single dose. Twenty years of argument have not fully settled what that costs.
Synthetic phenylpiperidine opioid — μ receptor agonist
Fentanyl Sublimaze · fentanyl citrate injection
A fast, short, haemodynamically quiet opioid — whose labelled adverse effect list puts muscle rigidity, including of the chest wall, in the very common category.
Class Ic antiarrhythmic (sodium channel blocker)
Flecainide Tambocor
Excellent at restoring sinus rhythm in a structurally normal heart, and lethal in a scarred one. The whole drug turns on that distinction.
Benzodiazepine receptor antagonist
Flumazenil Anexate
A clean, effective antagonist that is nonetheless the wrong answer to most overdoses. Knowing why is more useful than knowing the dose.
Reduced folate — bypasses dihydrofolate reductase blockade
Folinic acid Calcium folinate · Sodiofolin (disodium folinate) · (leucovorin)
The only cell-rescue antidote in routine use, dosed against a drug level rather than against the patient, and the one drug that must not be given near its own partner antidote.
Competitive alcohol dehydrogenase inhibitor
Fomepizole Fomepizole Waymade
It stops the poison becoming poisonous. In the UK it is licensed to do that for antifreeze and, on the label, not for methanol.
Pancreatic polypeptide hormone — glycogenolytic and positive inotrope
Glucagon GlucaGen · GlucaGen HypoKit
Two very different drugs share a name: 1 mg IM for the hypo in the ambulance, and a 10 mg off-label bolus for the beta-blocker overdose in resus. Only one of them is licensed.
Organic nitrate · nitric oxide donor
Glyceryl trinitrate GTN · Nitrolingual · Nitrocine
A preload reducer masquerading as a chest pain drug — which is why it transforms acute pulmonary oedema and harms the preload-dependent.
Quaternary ammonium antimuscarinic
Glycopyrronium bromide Glycopyrrolate · Robinul
Atropine's quaternary cousin: the same vagolytic effect at the heart, with far less of the delirium, the blurred vision and the pupils.
Hyperinsulinaemic euglycaemic therapy (HIET) — inodilator in cardiotoxic poisoning
High-dose insulin Actrapid · Humulin S (soluble human insulin)
An inodilator, not a vasopressor. It works, it takes half an hour to do so, and giving it without noradrenaline is the commonest way to make the patient worse.
Cobalt-containing vitamin B₁₂ precursor — direct cyanide chelator
Hydroxocobalamin Cyanokit (cyanide) · Neo-Cytamen (vitamin B₁₂ deficiency)
The cyanide antidote you can give to a hypotensive burns patient with a head injury and a normal haemoglobin, because it has no contraindications and does not make methaemoglobin.
Bradykinin B2 receptor antagonist
Icatibant Firazyr
The right drug for the rare angioedema, and — on the best evidence available — the wrong one for the common angioedema it keeps getting used for.
Humanised monoclonal antibody Fab fragment — specific dabigatran-binding reversal agent
Idarucizumab Praxbind
The only reversal agent on the estate with no contraindications, no dose calculation and no weight band. Two vials, fixed, every time — and it is useless against every anticoagulant except one.
Non-selective β₁/β₂ adrenoceptor agonist — chronotrope
Isoprenaline Isoprenaline hydrochloride · Midomil
A chemical pacing wire with a two-minute half-life. Prepared 2 mg in 500 mL, run at 0.5–10 µg/min, and titrated to symptoms rather than to a number.
NMDA receptor antagonist · dissociative anaesthetic
Ketamine Ketalar
The most useful drug in the department, and the one whose SmPC has drifted furthest from how it is actually used.
Carnitine — essential cofactor for mitochondrial fatty acid β-oxidation
Levocarnitine Levocarnitine Paediatric 30% oral solution · (Carnitor, not UK-listed)
A cofactor, not a chelator. It plausibly redirects valproate metabolism away from the toxic pathway, is close to harmless, and has never been shown in a controlled trial to help.
Amide local anaesthetic · class Ib antiarrhythmic
Lidocaine Xylocaine
The drug we give most often and calculate least often — and the one whose toxicity has a specific antidote most people cannot dose from memory.
Intravenous lipid emulsion — antidote in local anaesthetic systemic toxicity
Lipid emulsion Intralipid 20%
A bag of parenteral nutrition that is also the only antidote for a local anaesthetic cardiac arrest. The regimen most departments have laminated to the wall has been withdrawn.
Electrolyte · membrane stabiliser · anticonvulsant
Magnesium sulphate —
Three unrelated emergencies, three different regimens, and one unit muddle that causes most of the confusion.
α₁ agonist with indirect sympathomimetic action
Metaraminol Aramine
The vasopressor you can run peripherally while someone else puts in the central line — with a mechanism that guarantees it stops working.
Inhaled halogenated ether analgesic
Methoxyflurane Penthrox
The green whistle. Potent, fast, patient-controlled — and carrying a nephrotoxicity history that explains every dose cap on the label.
Thiazine dye — methaemoglobin reducing agent
Methylene blue Methylthioninium chloride Proveblue
An antidote that becomes the poison above its ceiling dose, is contraindicated in the deficiency it is most often given for, and causes serotonin syndrome with the commonest drug class in the country.
Beta-1 selective adrenoceptor antagonist
Metoprolol Betaloc · Lopresor
The UK's practical intravenous beta-blocker for acute rate control — and a drug whose label still recommends something COMMIT showed causes harm.
Short-acting imidazobenzodiazepine
Midazolam Midazolam solution for injection · Buccolam (oromucosal)
Three concentrations, a dose that halves after the age of sixty, and a reversal agent you should usually not reach for.
Competitive opioid receptor antagonist
Naloxone Prenoxad · Nyxoid
UK emergency practice now titrates from 100 micrograms, not from 400. The endpoint is a respiratory rate above 10 — not a conversation.
Endogenous catecholamine · α₁-predominant vasopressor
Noradrenaline Norepinephrine
The first-line vasopressor in shock — and the one whose UK ampoules express strength two different ways.
Somatostatin analogue — inhibits pancreatic insulin release
Octreotide Sandostatin · generic octreotide
The reason a sulfonylurea overdose keeps dropping its glucose is that you keep giving it glucose. Octreotide breaks that loop.
Medicinal gas — competitive displacement of carbon monoxide from haemoglobin
Oxygen Medicinal oxygen · Entonox (as a component)
The most-given antidote in the department, and the only one nobody thinks of as a drug. For carbon monoxide it is competitive displacement — the antidote is the substrate.
Oral thiol chelator; degradation product of penicillin
Penicillamine
The only orally licensed heavy-metal chelator in the UK, licensed for a poisoning it is rarely the best drug for.
Competitive non-selective α₁ and α₂-adrenoceptor antagonist
Phentolamine Phentolamine mesilate 10 mg/mL
Now licensed again in the UK — for phaeochromocytoma. The use every ED knows it for, rescuing an extravasated noradrenaline, appears nowhere on the label.
Vitamin K₁ — cofactor for γ-carboxylation of factors II, VII, IX and X
Phytomenadione Konakion MM · Konakion MM Paediatric
Cheap, slow and indispensable. It does nothing for four hours, which is why it never goes alone — and it must not go into a muscle.
Oxime — reactivator of organophosphate-inhibited acetylcholinesterase
Pralidoxime Pralidoxime mesilate (P2S) — no UK licensed product
The nicotinic half of organophosphate treatment: a plausible mechanism, a time limit measured in minutes for some agents, and a randomised trial of the WHO dose that found no benefit and a point estimate pointing towards harm.
Class Ia antiarrhythmic (sodium channel blocker)
Procainamide Pronestyl
Promoted to first-line for stable VT in the 2025 algorithm — and stocked by remarkably few UK departments.
Antimuscarinic antiparkinsonian agent — restores dopamine–acetylcholine balance in the striatum
Procyclidine Kemadrin · Arpicolin
The drug that reverses an acute dystonic reaction in minutes — a genuinely satisfying piece of emergency medicine, now complicated by the disappearance of the only formulation that worked in a patient with a locked jaw.
Intravenous general anaesthetic — GABA-A receptor potentiator
Propofol Propofol 1% · Diprivan
The most reliable induction agent available and the one most likely to drop the blood pressure of the patient who could least afford it.
Cationic polypeptide — forms an inert ionic complex with heparin
Protamine sulfate Prosulf
A fish-sperm protein that neutralises heparin by electrostatic attraction, and kills people by being pushed in too fast. The dose falls as the clock runs.
Four-factor human plasma-derived coagulation factor concentrate (II, VII, IX, X)
Prothrombin complex concentrate Octaplex · Beriplex
Factors II, VII, IX and X in 40 mL instead of four units of plasma. It corrects the INR in minutes and wears off in hours — which is why vitamin K is not optional.
Non-absorbed ion-exchange resin; ferric hexacyanoferrate(II)
Prussian Blue
A pigment that traps thallium in the gut, chosen as the antidote of choice mainly because everything else is worse.
Vitamin B₆ — precursor of pyridoxal 5′-phosphate, cofactor for glutamate decarboxylase
Pyridoxine Pyridoxine 50 mg tablets · Pabrinex (as a component)
Refractory seizures with a profound lactic acidosis in someone on tuberculosis treatment is a vitamin deficiency you can reverse in minutes — if you can find the intravenous preparation, which is not licensed in the UK.
Aminosteroid non-depolarising neuromuscular blocking agent
Rocuronium Esmeron (discontinued) · generic rocuronium bromide
One milligram per kilogram gives intubating conditions in sixty seconds. Sugammadex removed the objection that used to make people choose suxamethonium instead.
Parenteral polyaminocarboxylic acid chelator (edetate calcium disodium)
Sodium Calcium Edetate
The intravenous lead chelator with the most experience behind it, one word away from a drug that causes fatal hypocalcaemia.
Alkalinising agent — sodium loading and pH manipulation
Sodium bicarbonate Sodium Bicarbonate 8.4% w/v
8.4% is 1 mmol per millilitre. It is a genuinely specific antidote in sodium-channel-blocker poisoning and a largely discredited reflex in everything else.
Methaemoglobin former plus sulphur donor — the two-step cyanide antidote
Sodium nitrite and sodium thiosulphate Nithiodote · Sodium Thiosulfate Solution for Injection
An antidote that deliberately poisons the haemoglobin to save the mitochondria. It works, and it has killed at less than twice the therapeutic dose.
Oral dithiol chelator; meso-2,3-dimercaptosuccinic acid
Succimer (DMSA)
The oral lead chelator with no demonstrated disadvantage against the intravenous one, and which no UK company sells.
Modified γ-cyclodextrin selective relaxant binding agent
Sugammadex Bridion
Encapsulates rocuronium and reverses paralysis in minutes. What it cannot do is give an apnoeic patient somewhere to breathe.
Depolarising neuromuscular blocking agent
Suxamethonium Suxamethonium chloride · succinylcholine
The fastest onset and shortest duration of any paralytic, and a contraindication list that reads like a description of the emergency department's caseload.
Antifibrinolytic · lysine analogue
Tranexamic acid Cyklokapron
Cheap, stable and genuinely life-saving in the right bleed — and clearly not a general-purpose haemostatic, as HALT-IT settled.
Vasopressin V1/V2 receptor agonist — non-catecholamine vasopressor
Vasopressin Argipressin
A vasopressor that works when catecholamines have stopped working — and whose UK licence mentions neither shock nor cardiac arrest.
Non-dihydropyridine calcium channel blocker (class IV)
Verapamil Securon · Isoptin
Effective, cheap and unforgiving. Two specific errors with verapamil kill patients, and both are avoidable at the bedside.
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