atropine/pralidoxime (Rx)

Brand and Other Names:ATNAA, DuoDote
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Dosing & Uses

AdultPediatric

Organophosphate Insecticide or Nerve Agent Poisoning Symptom Criteria

Mild symptoms: Bradycardia, chest tightness, breathing difficulties, blurred vision, drooling miosis, vomiting, runny nose, stomach cramps (acute onset), salivation, teary eyes, wheezing/coughing, tremors/muscular twitching, airway secretions increased

Severe symptoms: Confused/strange behavior, involuntary urination/defecatioin, muscular twitching/generalized weakness (severe), severe breathing difficulties, convulsions, copious secretion from lung or airway

Organophosphate, Insecticide or Nerve Agent Poisoning

2.1 mg atropine/0.7 mL + 600 mg pralidoxime/2 mL IM into outer thigh or buttocks

Mild symptoms: 1 injection; if after 10-15 min there are no severe symptoms experienced, no further injections are necessary; if severe symptoms experienced following initial injection, give 2 additional injections in rapid succession

Severe symptoms (>1 severe symptom): 3 injections in rapid succession

Maximum dose: Not to exceed 3 injections unless medical care support available

Renal Impairment

Caution; parlidoxime is renally eliminated

Safety and efficacy not established

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Interactions

Interaction Checker

and atropine/pralidoxime

No Results

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    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

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            Adverse Effects

            Frequency Not Defined

            Injection site pain

            Flushing

            Urinary retention

            Hypertension (transient; usually occurs 15 min following injection)

            Asystole

            Palpations

            Anaphylaxis

            Closed angle glaucoma

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            Warnings

            No absolute contraindications

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            Pregnancy & Lactation

            Pregnancy Category: C

            Lactation: Excretion in milk unknown; use with caution

            Pregnancy Categories

            A:Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B:May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C:Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D:Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X:Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA:Information not available.

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            Formulary

            FormularyPatient Discounts

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            The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
            ST Step Therapy
            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
            OR Other Restrictions
            Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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