Antidotes for nonchemotherapy drug extravasation
| Extravasated drug | Classification: vesicant or irritant | Immediate topical treatment | Antidote |
|---|---|---|---|
| Acyclovir2,5-7 | Irritant or vesicant; alkaline agent (pH 11) | Cooling | Hyaluronidase |
| Aminophylline2,4 | Vesicant; alkaline agent (pH 8–10) | Warming | Hyaluronidase |
| Amiodarone1,6,8 | Vesicant; acidic agent (pH 3.5–4.5) | Warming | Hyaluronidase |
| Amphotericin B4 | Vesicant; acidic agent (pH 5–7) | Cooling | Hyaluronidase; for liposomal, consider flushout instead |
| Ampicillin4 | Vesicant; hyperosmolar agent | Warming | Hyaluronidase |
| Calcium chloride 10%2,4 | Vesicant; hyperosmolar agent | Warming | Early-onset: hyaluronidase Delayed-onset: sodium thiosulfate |
| Dantrolene4 | Vesicant; alkaline agent (pH 9.5–10.3) | Warming | Hyaluronidase |
| Dextrose 10%–50%4 | Vesicant; hyperosmolar agent | Warming | Hyaluronidase |
| Dobutamine2,4 | Vesicant; vasopressor | Warming | First-line: phentolamine Second-line: terbutaline/topical nitroglycerin |
| Dopamine2,4 | Vesicant; vasopressor | Warming | First-line: phentolamine Second-line: terbutaline/topical nitroglycerin |
| Doxycycline4 | Vesicant; acidic agent (pH 1.8–3.3) | Warming | Hyaluronidase |
| Epinephrine2,4 | Vesicant; vasopressor | Warming | First-line: phentolamine Second-line: terbutaline/topical nitroglycerin |
| Esmolol4 | Vesicant; acidic agent (pH 4.5–6.5) | Warming (no literature support) | Hyaluronidase |
| Etomidate2,4 | Irritant (rarely vesicant); hyperosmolar agent | Warming (no literature support) | Hyaluronidase |
| Lorazepam4 | Vesicant; hyperosmolar agent | Warming (no literature support) | Hyaluronidase |
| Mannitol 20%4 | Vesicant; hyperosmolar agent | Warming | Hyaluronidase |
| Metronidazole4 | Vesicant; acidic agent (pH 5.5) | Warming (no literature support) | Hyaluronidase |
| Methylene blue4 | Vesicant; vasopressor | Warming (no literature support) | First-line: topical nitroglycerin Second-line: phentolamine or terbutaline |
| Nafcilllin4 | Vesicant or irritant | Warming | Hyaluronidase |
| Nitroglycerin2 | Vesicant; hyperosmolar agent | Warming or cooling | Hyaluronidase |
| Norepinephrine2,4 | Vesicant; vasopressor | Warming | First-line: phentolamine Second-line: terbutaline/topical nitroglycerin |
| Parenteral nutrition2,4 | Vesicant; hyperosmolar agent | Warming | Hyaluronidase, nitroglycerin |
| Pentobarbital4 | Vesicant; alkaline agent (pH 9–10.5) | Warming | Hyaluronidase |
| Phenobarbital2,4 | Vesicant; hyperosmolar agent | Warming (no literature support) | Hyaluronidase |
| Phenylephrine2,4 | Vesicant; vasopressor | Warming | First-line: phentolamine Second-line: topical nitroglycerin |
| Phenytoin and fosphenytoin2,4 | Vesicant; alkaline agent (pH 10–12) | Warming | Hyaluronidase or nitroglycerin |
| Potassium chloride2,4 | Irritant; hyperosmolar agent | Warming | Hyaluronidase |
| Potassium phosphate6 | Irritant; hyperosmolar agent | Cooling | Hyaluronidase |
| Sodium bicarbonate 8.4%2,4 | Vesicant; hyperosmolar agent | Warming | Hyaluronidase |
| Sodium chloride (> 3%)2,4 | Vesicant; hyperosmolar agent | Warming | Hyaluronidase |
| Sodium phosphate4 | Vesicant; hyperosmolar agent | Warming | Hyaluronidase |
| Penicillin4 | Vesicant | Warming (no literature support) | Hyaluronidase |
| Valproate4 | Vesicant | Cooling | Hyaluronidase with washout |
| Vancomycin4 | Irritant or vesicant; acidic agent | Warming (no literature support) | Hyaluronidase |
| Vasopressin4 | Vesicant; vasopressor | Warming | First-line: topical nitroglycerin Second-line: phentolamine or terbutaline |