Urgent poisons advice
If a person presents with an overdose, consult TOXBASE (registration required, see below) to find information on the specific poison(s) and manage accordingly.
Telephone the National Poisons Information Service (NPIS) on 0344 892 0111 for advice if:
- poisoning is severe or complex (for example, multiple ingestions)
- the person has significant morbidity
- there are uncertainties regarding management after consulting TOXBASE online
- the poison is unknown
TOXBASE is the clinical toxicological database of the UK National Poisons Information Service (NPIS) and should be the first port of call for healthcare professionals seeking poisons information in the UK. Access is via mobile app or online and requires registration.
Available for Apple and android devices, full access is free for individuals who register with their NHS email address. Registration for the app takes several minutes:
- Download and enter the required details (including a username and password, your professional registration number and NHS email address) .
- You will immediately receive a verification email to that address.
- Click on the link in the email. You can then log in to the app.
GP practices and other NHS units can register for free online access. Applications must be submitted by a senior clinical or manager willing to become an Account Holder for their unit/practice; registration takes 1-2 working days. A back-up site is available at www.toxbasebackup.org if the main site cannot be accessed.
Monographs are available for over 21,000 medicines, chemicals, household products, plants and substances of abuse. Each monograph includes:
- an alert box advising which situations require people to be referred for medical assessment
- information on symptoms of toxicity, case reports and pharmacokinetics such as peak plasma concentration
- advice on management with specific step-by-step guidance
Printable versions of monographs are available for the management of individual patients. Printouts should not be kept for future reference as advice may change.
Also useful are these leaflets on potentially serious poisonings and low-risk substances:
In addition to TOXBASE, the following resources may be helpful and are free to access.
British National Formulary
The British National Formulary (BNF) and BNF for Children (BNFC) contain a treatment summary of Poisoning, emergency treatment which provides general advice such as:
- toxic effects on different body systems
- poison removal and elimination
They also provide an overview on management of poisoning from around thirty specific medicines, drug classes and other substances including two forms of paracetamol poisoning – acute overdose and therapeutic excess.
For specific management advice, consult TOXBASE.
Summaries of Product Characteristics
SmPCs/SPCs are available from electronic Medicines Compendium and MHRA. Useful sections include:
- Posology and method of administration (4.2) to check the usual maximum dose
- Overdose (4.9) for information on symptoms and management of overdose
- Pharmacokinetic properties (5.2) to determine peak plasma concentration and half-life
SPS Medicines Advice
Our Medicines Advice service can support primary care health professionals regarding situations such as:
- accidental ingestion of an additional dose of person’s own medicine
- when to restart medication following accidental overdose
- tablet identification
If you would like more information on how to approach answering questions on poisoning or medicines toxicity we recommend:
UK NPIS provide two e-learning modules for healthcare professionals in general practice or NHS hospitals:
- Using TOXBASE
- Clinical management of the poisoned patient
Registration at TOXlearning is needed; it is free for people registering with an NHS email address.