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pralidoxime

V03AB04

Forms & Strengths

Injection: 1 g single-dose vial (reconstitution required)
Auto-injector: 600 mg / 2 mL (Duodote)

Adult Dosing

Organophosphate poisoning: 1 to 2 g IV administered over 15 to 30 minutes, or as a continuous IV infusion of 200 to 500 mg/hour
Repeat dose in 1 hour if muscle weakness persists; subsequent doses may be given every 10 to 12 hours if cholinergic signs recur

Pediatric Dosing

Organophosphate poisoning: 20 to 50 mg/kg/dose IV administered over 15 to 30 minutes
May repeat dose in 1 hour if indicated, followed by repeat doses every 10 to 12 hours as needed

Indications

Antidote for poisoning by organophosphate pesticides and chemicals (acetylcholinesterase inhibitors)
Control of overactivity at muscarinic and nicotinic junctions caused by nerve agents

Mechanism of Action

Reactigvates acetylcholinesterase that has been inactivated by phosphorylation due to an organophosphate pesticide or nerve agent
Binds to the organophosphate-enzyme complex, promoting release of the chemical and restoring normal enzyme function at neuromuscular junctions and autonomic sites

Contraindications

Hypersensitivity to pralidoxime or any component of the formulation
Poisoning by carbaryl (Sevin), as pralidoxime may potentiate carbaryl toxicity

Adverse Reactions

Rapid IV administration can cause tachycardia, laryngospasm, and transient hypertension
Blurred vision, diplopia, and impaired accommodation
Dizziness, headache, drowsiness, and nausea
Pain and localized thrombophlebitis at the injection site

Drug Interactions

Barbiturates and other central nervous system depressants: Effects may be potentiated
Succinylcholine: Pralidoxime may prolong the neuromuscular blocking action of depolarizing agents
Aminophylline, theophylline, morphine, and reserpine: Use with caution as certain adverse effects may be exacerbated in organophosphate toxicity management

Curated Content: Needs Vetting Before Put to Clinical Use