Table 3.

Antidotes for Amatoxin poisoning (recommended doses are based on previously published reports)

Antidote	Mechanism of action	Dose
Silibinina	Competes with amatoxins for transmembrane transport; inhibits penetration of amanitin into hepatocytes; scavenges free radicals; produces anti-inflammatory effects; increases ribosomal RNA synthesis, resulting in increased protein synthesis	5 mg/kg IV over 1 h; then 20 mg/kg/24 h continuous infusion (diluted in 5 % glucose to a concentration of 2 mg silibinin/ml) for 3 days (alternatively, the 20 mg/kg/24 h can be divided into six hourly doses)
N-acetylcysteine (NAC)	Promotes glutathione regeneration; scavenges free radicals	Follow dosing for APAP treatment: 150 mg/kg IV over 1 h, followed by 12.5 mg/kg/h for 4 h, followed by 6.25 mg/kg/h until evidence of hepatic failure resolution

Sources: Ahishali et al. [26]; Berger and Guss [29] and Berger and Guss [30]; Bergis et al. [31]; Diaz [8, 32]; Karlson-Stiber and Persson [33]; Magdalan et al. [34] and Magdalan et al. [35]; Roberts et al. [36]; Sorodoc et al. [37]; Trabulus and Altiparmak [38]; Ward et al. [19]

^aSilibinin is not approved as a therapeutic treatment for hepatic disease by the Food and Drug Administration in the USA; it may be available through clinicaltrials.gov; it is approved and available in parts of Europe and Australia