Current antidotes for intravenous extravasation
| Antidote | Mechanism and use | Preparation | Administration |
|---|---|---|---|
| Sodium thiosulfate5–7 | Neutralizes reactive species and reduces formation of hydroxyl radicals that can cause tissue injury Used as first line for most vesicants | From 25% sodium thiosulfate solution: mix 1.6 mL with 8.4 mL sterile water for injection From 10% sodium thiosulfate solution: mix 4 mL with 6 mL sterile water for injection | Use 2 mL of the prepared solution for each 1 mg of drug extravasated |
| Hyaluronidase7 | Hydrolyzes hyaluronic acid in connective tissue, possibly leading to dilution and diffusion of extravasated drug Used as first line for most vesicants | To obtain a 15-unit/mL concentration, mix 0.1 mL (of 150 units/mL) with 0.9 mL of 0.9% sodium chloride in 1-mL syringe Usually dosed as 15 to 25 units intradermally over 5 injections | Ideally administer within 1 hour of the event |
| Phentolamine5,7 | Alpha-adrenergic antagonist that promotes vasodilation and capillary blood flow Used as preferred agent for vasopressors | 5 to 10 mg in 10 to 20 mL of 0.9% sodium chloride | Administer within 12 to 13 hours of the injury |
| Nitroglycerin topical5,7 | Increases nitric oxide, promoting vasodilation Used for vasopressors (alternative to phentolamine | 2% ointment: A half-inch of ointment equals 7.5 mg of nitroglycerin 5-mg/day transdermal patch | 1-inch strip applied to site of ischemia; can re-dose every 8 hours as necessary 1 patch daily |
| Terbutaline5,7 | Alpha-adrenergic agonist that promotes vasodilation and capillary blood flow Used for vasopressors (alternative to phentolamine) | 1 mg in 10 mL of 0.9% sodium chloride | Inject locally across symptomatic sites |