Antidotes Poisoning/toxicity Antidote or reversal agent Opioids Naloxone Benzodiazepines Flumazenil in selected cases Acetaminophen/paracetamol N-acetylcysteine Heparin Protamine Warfarin Vitamin K; PCC for urgent reversal when indicated Dabigatran Idarucizumab Methanol/ethylene glycol Fomepizole Organophosphates Atropine + pralidoxime when indicated Digoxin Digoxin-specific antibody fragments Iron Deferoxamine in severe poisoning Cyanide Hydroxocobalamin-based treatment Methemoglobinemia Methylene blue in appropriate cases Malignant hyperthermia Dantrolene Local anesthetic systemic toxicity Lipid emulsion therapy, alongside resuscitation Methotrexate toxicity Leucovorin in appropriate regimens
Important: Flumazenil can precipitate seizures in benzodiazepine-dependent patients or mixed overdoses; it is not a universal antidote for an unconscious patient.
Anticoagulants versus antiplatelets Feature Anticoagulants Antiplatelets Main target Coagulation factors Platelet activation/aggregation Examples Warfarin, heparin, apixaban Aspirin, clopidogrel Main use Prevention/treatment of thromboembolism Prevention of arterial thrombosis Dental concern Bleeding risk Bleeding risk
IMPORTANT DRUG INTERACTIONS Classic drug interactions Combination Main risk or effect Mechanism Warfarin + metronidazole Increased bleeding Reduced warfarin metabolism Warfarin + rifampin Reduced anticoagulation Enzyme induction Nitrates + PDE-5 inhibitors Severe hypotension Excessive cGMP-mediated vasodilation ACE inhibitor/ARB + potassium-sparing diuretic Hyperkalemia Reduced potassium excretion Opioid + benzodiazepine Respiratory depression Additive CNS depression SSRI/SNRI + MAOI Serotonin syndrome Excess serotonergic activity Macrolide + QT-prolonging drug Arrhythmia risk Additive QT prolongation Methotrexate + trimethoprim Marrow toxicity Additive antifolate effects Lithium + NSAID Lithium toxicity Reduced renal lithium clearance Rifampin + oral contraceptives Reduced contraceptive efficacy Enzyme induction
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