pralidoxime (Rx)Brand and Other Names:Protopam, 2PAM Antidote, more...Pralidoxime Auto Injector

 
 
 

Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

injectable, powder for reconstitution

  • 1g/vial
more...

Organophosphate Poisoning

1-2 g IV as 15-30 min infusion, repeat in 1 hr if necessary, OR

Use with atropine, which affects muscarinic receptors; pralidoxime's actions most striking at nicotonic sites (increase muscle strength 10-40 min)

IM: 600 mg IM x3 doses; administer each dose 15 minutes apart for mild symptoms, or in rapid succession for severe symptoms

Renal Impairment: Reduce dose

Acetylcholinesterase Inhibitor Toxicity

Initial: 30 mg/kg IV (IM, SC if no IV access) over 20 min

4-8 mg/kg/hr IV infusion

Other Indications & Uses

Toxicity caused by insecticides and related nerve gases (eg, tabun, sarin, soman)

Dosage Forms & Strengths

injectable, powder for reconstitution

  • 1g/vial
more...

Organophosphate Poisoning

IV loading dose followed by continuous infusion

  • 20-50 mg/kg/dose (not to exceed 2 g/dose) infused IV over 15-30 minutes
  • Maintenance: 10-20 mg/kg/hr IV continuous infusion 

IV intermittent infusions

  • 20-50 mg/kg (not to exceed 2 g/dose) IV infused over 15-30 minutes 
  • A second dose of 20-50 mg/kg may be indicated after about 1 hr if muscle weakness has not been relieved
  • May repeat q10-12hr prn

Other IV administration

  • If it is not practical to administer intermittent or continuous IV infusions, or if pulmonary edema is present, the 20-50 mg/kg dose should be given slowly (infused over at least 5 minutes) by IV injection as a 50 mg/mL solution in water
  • Additional doses may be given every 10-12 hours if muscle weakness persists

IM administration

  • <40 kg: 15 mg/kg/dose IM x3 doses 
  • 40 kg or greater: Administer as in adults; 600 mg/dose IM x3 doses
  • Administer each dose 15 minutes apart for mild symptoms, or in rapid succession for severe symptoms
  • Administer in the anterolateral aspect of the thigh to avoid the nerve, artery and vein, as well as the femur

Renal Impairment

Reduce dose

Next

Interactions

Interaction Checker

pralidoxime and

No Results

     
     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

            Sort by :  
             activity indicator 
            Previous
            Next

            Adverse Effects

            Frequency Not Defined

            Pain at site

            Transient dizziness

            Blurred vision

            Double vision

            Hypertension

            Tachycardia

            Laryngospasm

            Muscle rigidity

            Respiratory/cardiac arrest if given too fast IV

            Headache

            Drowsiness

            Nausea

            Previous
            Next

            Warnings

            Cautions

            Administer concomitant atropine

            Not equally active against all organophosphates

            Give IM if pt is cyanotic

            Observe pt for at least 24 hr

            Previous
            Next

            Pregnancy & Lactation

            Pregnancy Category: C

            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.

            more...
            Previous
            Next

            Pharmacology

            Onset: 5-15 min

            Mechanism of Action

            Binds to organophosphates and breaks alkyl phosphate-cholinesterase bond to restore activity of acetylcholinesterase

            Previous
            Next

            Administration

            IV Preparation

            Reconstitute by adding 20 mL SWI to the 1 g vial to provide a 50 mg/mL solution (do not use preservative-containing solutions)

            Use within a few hours

            IV Administration

            For infusion, dilute required amount of reconstituted solution to 100 mL with NS

            Infuse over 15-30 min

            May also be given as 5 min slow IVP

            IM Administration

            1 g vial contents may be reconstituted by adding 3 mL SWI or NS to provide a 300 mg/mL solution

            Previous
            Next

            Images

            Previous
            Next

            Formulary

            FormularyPatient Discounts

            To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.

            Adding plans allows you to:

            • View the formulary and any restrictions for each plan.
            • Manage and view all your plans together – even plans in different states.
            • Compare formulary status to other drugs in the same class.
            • Access your plan list on any device – mobile or desktop.

            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.
            Add or Remove Plans
            Plans for
            Select State:
            Non-Medicare PlansMedicare Plans

            Select a box to add or remove a plan.

            Select a class to view formulary status for similar drugs

            Additional Offers
            Email to Patient

            From:

            To:

            The recipient will receive more details and instructions to access this offer.

            By clicking send, you acknowledge that you have permission to email the recipient with this information.

            Email Forms to Patient

            From:

            To:

            The recipient will receive more details and instructions to access this offer.

            By clicking send, you acknowledge that you have permission to email the recipient with this information.

            Previous
             
             
             
            All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.