Acute poisoning is one of the more frequent presentations in acute and emergency medicine. Poisoning with pharmaceuticals is predominantly observed in adults. A detailed medical history and an accurate clinical examination establish the basis for the diagnostics. Typical poisoning syndromes can be classified based on the clinical presentation. Drug screening in urine and examination of blood alcohol levels are useful additional tools because of the rapid and widespread availability. Securing vital organ functions is the mainstay of treatment and early contact with a poisons centre is useful for the assessment of the hazard and the further procedures. Primary and secondary poison elimination methods should be carefully considered because of insufficient evidence. Specific antidotes are only available for a few poisoning cases.