Medication Summary
No drug has been shown to reverse the effects of tetrodotoxin poisoning. Treatment is symptomatic. Specific drug efficacy has only been documented anecdotally.
Anticholinesterase drugs (eg, neostigmine) have been proposed as a treatment option but have not been tested adequately. [15]
GI decontaminants
Class Summary
Empirically used to minimize systemic absorption of the toxin. May only benefit if administered within 1-2 h of ingestion.
Activated charcoal (Liqui-Char)
Emergency treatment in poisoning caused by drugs and chemicals. Network of pores present in activated charcoal adsorbs 100-1000 mg of drug per gram of charcoal. Does not dissolve in water.
For maximum effect, administer within 30 min of ingesting poison. Generally mixed and given with a cathartic (eg, 70% sorbitol), except in young pediatric patients in whom electrolyte disturbances may be of concern.
Cholinergic agents
Class Summary
May be useful in reversing the neurological complications of the venom; however, they should not be a substitute for airway management.
Neostigmine (Prostigmin)
Although not clinically proven, neostigmine has been used anecdotally to restore motor strength. Inhibits destruction of acetylcholine by acetylcholinesterase, which facilitates transmission of impulses across myoneural junction.
Repeat doses based on patient's response.
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Puffer fish.
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Chemical structure of tetrodotoxin.
