pralidoxime (Rx)

Brand and Other Names:Protopam, 2PAM Antidote, more...Pralidoxime Auto Injector
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Dosing & Uses

AdultPediatricGeriatric

Dosage Forms & Strengths

powder for reconstitution

  • 1g/vial

injection solution

  • 300 mg/mL
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Organophosphate Poisoning

1-2 g IV infusion (10-20 mg/mL) over 15-30 min, repeat in 1 hr if necessary and repeat q12hr thereafter PRN; if not practical or if pulmonary edema present or fluid restriction necessary administer as 50 mg/mL over 5 min; a second bolus of 1-2 g may be indicated after about 1 hr if muscle weakness has not been relieved; may repeat q10-12hr prn

Alternatively, administer 30 mg/kg IV (IM, SC if no IV access) over 20 min; follow by 4-8 mg/kg/hr maintenance IV infusion

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; not to exceed 1800 mg total dose initially; if symptoms persist may repeat series of three injections 1 hr after last injection

Acetylcholinesterase Inhibitor Toxicity (Neostigmine, Pyridostigmine)

1-2 g IV followed by 250 mg increments q5min PRN

Renal Impairment

Reduce dose; no specific recommendations provided by manufacturer

Dosage Forms & Strengths

powder for reconstitution

  • 1g/vial

injection solution

  • 300 mg/mL
more...

Organophosphate Poisoning

< 16 years

  • 20-50 mg/kg/dose (not to exceed 2 g/dose) IV; follow by 10-20 mg/kg/hr IV continuous infusion for maintenance; alternatively may repeat bolus of 20-50 mg/kg/dose over 1 hr and repeat q10-12hr if muscle weakness has not bee relieved

> 16 years

  • 1-2 g IV infusion (10-20 mg/mL) over 15-30 min, repeat in 1 hr if necessary and repeat q12hr thereafter PRN; if not practical or if pulmonary edema present or fluid restriction necessary administer as 50 mg/mL over 5 min; a second bolus of 1-2 g may be indicated after about 1 hr if muscle weakness has not been relieved; may repeat q10-12hr prn
  • Alternatively, administer 30 mg/kg IV (IM, SC if no IV access) over 20 min; follow by 4-8 mg/kg/hr maintenance IV infusion

IM administration

  • <40 kg: 15 mg/kg/dose IM x3 doses administered q15min for mild symptoms; not to exceed 45 mg/kg or in rapid succession for severe symptoms 
  • >40 kg or greater: 600 mg IM x3 doses; administer each dose 15 minutes apart for mild symptoms, or in rapid succession for severe symptoms; not to exceed 1800 mg total dose initially
  • If symptoms persist may repeat series of three injections 1 hr after last injection
  • Administer in the anterolateral aspect of the thigh to avoid the nerve, artery and vein, as well as the femur

Administer with caution; consider possibility of decreased renal, hepatic, and renal function

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Interactions

Interaction Checker

and pralidoxime

No Results

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    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

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            Adverse Effects

            Frequency Not Defined

            Pain at site

            Transient dizziness

            Blurred vision

            Double vision

            Dizziness

            Hypertension

            Tachycardia

            Cardiac arrest

            Laryngospasm

            Muscle rigidity

            ALT (transient increase); AST (transient increase)

            Respiratory/cardiac arrest if given too fast IV

            Headache

            Seizure

            Drowsiness

            Nausea

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            Warnings

            Contraindications

            None for the approved indications

            Cautions

            Administer concomitant atropine

            Not approved for the treatment of carabamate poisoning

            Not indicated for poisoning resulting from inorganic phosphates, phosphorus, or organophosphates that do not involve anticholinesterase activity

            Use caution in myasthenia gravis (may presipitate myasthenia crisis)

            Not equally active against all organophosphates

            Give IM if patient is cyanotic

            Observe patients for at least 24 hr

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            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.

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            Pharmacology

            Mechanism of Action

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

            Pharmacokinetics

            Onset: 5-15 min

            Vd: 0.6-2.7 L/kg (may increase in severe organophosphate intoxication)

            Protein binding: None

            Metabolism: Hepatic

            Half-life: 3-4 hr (IM, IV)

            Excretion: 80%

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            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

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            Formulary

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            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.
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            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
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