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

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

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

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              • pramlintide

                pramlintide, pralidoxime. Either increases effects of the other by pharmacodynamic synergism. Contraindicated. Synergistic inhibition of GI motility.

              Monitor Closely (90)

              • aclidinium

                pralidoxime and aclidinium both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • amitriptyline

                pralidoxime and amitriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • amoxapine

                pralidoxime and amoxapine both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • anticholinergic/sedative combos

                anticholinergic/sedative combos and pralidoxime both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • aripiprazole

                pralidoxime decreases levels of aripiprazole by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

                pralidoxime decreases levels of aripiprazole by pharmacodynamic antagonism. Use Caution/Monitor.

                aripiprazole increases effects of pralidoxime by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

              • atracurium

                atracurium and pralidoxime both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • atropine

                atropine and pralidoxime both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • atropine IV/IM

                atropine IV/IM and pralidoxime both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • belladonna alkaloids

                belladonna alkaloids and pralidoxime both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • belladonna and opium

                belladonna and opium and pralidoxime both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • benperidol

                pralidoxime decreases levels of benperidol by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

                pralidoxime decreases levels of benperidol by pharmacodynamic antagonism. Use Caution/Monitor.

                benperidol increases effects of pralidoxime by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

              • benztropine

                benztropine and pralidoxime both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • bethanechol

                bethanechol increases and pralidoxime decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • carbachol

                carbachol increases and pralidoxime decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • cevimeline

                cevimeline increases and pralidoxime decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • chlorpromazine

                pralidoxime decreases levels of chlorpromazine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

                pralidoxime decreases levels of chlorpromazine by pharmacodynamic antagonism. Use Caution/Monitor.

                chlorpromazine increases effects of pralidoxime by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

              • cisatracurium

                cisatracurium and pralidoxime both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • clomipramine

                pralidoxime and clomipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • clozapine

                pralidoxime decreases levels of clozapine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

                pralidoxime decreases levels of clozapine by pharmacodynamic antagonism. Use Caution/Monitor.

                clozapine increases effects of pralidoxime by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

              • cyclizine

                cyclizine and pralidoxime both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • cyclobenzaprine

                cyclobenzaprine and pralidoxime both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • darifenacin

                darifenacin and pralidoxime both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • desipramine

                pralidoxime and desipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • dicyclomine

                dicyclomine and pralidoxime both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • diphenhydramine

                diphenhydramine and pralidoxime both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • donepezil

                donepezil increases and pralidoxime decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • dosulepin

                pralidoxime and dosulepin both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • doxepin

                pralidoxime and doxepin both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • droperidol

                pralidoxime decreases levels of droperidol by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

                pralidoxime decreases levels of droperidol by pharmacodynamic antagonism. Use Caution/Monitor.

                droperidol increases effects of pralidoxime by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

              • echothiophate iodide

                echothiophate iodide increases and pralidoxime decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • fesoterodine

                fesoterodine and pralidoxime both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • flavoxate

                flavoxate and pralidoxime both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • fluphenazine

                pralidoxime decreases levels of fluphenazine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

                pralidoxime decreases levels of fluphenazine by pharmacodynamic antagonism. Use Caution/Monitor.

                fluphenazine increases effects of pralidoxime by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

              • galantamine

                galantamine increases and pralidoxime decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • glycopyrrolate

                glycopyrrolate and pralidoxime both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • glycopyrrolate inhaled

                glycopyrrolate inhaled and pralidoxime both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • haloperidol

                pralidoxime decreases levels of haloperidol by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

                pralidoxime decreases levels of haloperidol by pharmacodynamic antagonism. Use Caution/Monitor.

                haloperidol increases effects of pralidoxime by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

              • henbane

                henbane and pralidoxime both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • homatropine

                homatropine and pralidoxime both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • huperzine A

                huperzine A increases and pralidoxime decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • hyoscyamine

                hyoscyamine and pralidoxime both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • hyoscyamine spray

                hyoscyamine spray and pralidoxime both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • iloperidone

                pralidoxime decreases levels of iloperidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

                pralidoxime decreases levels of iloperidone by pharmacodynamic antagonism. Use Caution/Monitor.

                iloperidone increases effects of pralidoxime by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

              • imipramine

                pralidoxime and imipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • ipratropium

                ipratropium and pralidoxime both decrease cholinergic effects/transmission. Use Caution/Monitor. Due to the poor systemic absorption of ipratropium, interaction unlikely at regularly recommended dosages.

              • lofepramine

                pralidoxime and lofepramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • loxapine

                pralidoxime decreases levels of loxapine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

                pralidoxime decreases levels of loxapine by pharmacodynamic antagonism. Use Caution/Monitor.

                loxapine increases effects of pralidoxime by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

              • loxapine inhaled

                loxapine inhaled increases effects of pralidoxime by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

                pralidoxime decreases levels of loxapine inhaled by pharmacodynamic antagonism. Use Caution/Monitor.

              • maprotiline

                pralidoxime and maprotiline both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • meclizine

                meclizine and pralidoxime both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • methscopolamine

                methscopolamine and pralidoxime both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • neostigmine

                neostigmine increases and pralidoxime decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • nortriptyline

                pralidoxime and nortriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • olanzapine

                pralidoxime decreases levels of olanzapine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

                pralidoxime decreases levels of olanzapine by pharmacodynamic antagonism. Use Caution/Monitor.

                olanzapine increases effects of pralidoxime by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

              • onabotulinumtoxinA

                onabotulinumtoxinA and pralidoxime both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • orphenadrine

                pralidoxime and orphenadrine both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • oxybutynin

                oxybutynin and pralidoxime both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • oxybutynin topical

                oxybutynin topical and pralidoxime both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • oxybutynin transdermal

                oxybutynin transdermal and pralidoxime both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • paliperidone

                pralidoxime decreases levels of paliperidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

                pralidoxime decreases levels of paliperidone by pharmacodynamic antagonism. Use Caution/Monitor.

                paliperidone increases effects of pralidoxime by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

              • pancuronium

                pancuronium and pralidoxime both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • perphenazine

                pralidoxime decreases levels of perphenazine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

                pralidoxime decreases levels of perphenazine by pharmacodynamic antagonism. Use Caution/Monitor.

                perphenazine increases effects of pralidoxime by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

              • physostigmine

                physostigmine increases and pralidoxime decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • pilocarpine

                pilocarpine increases and pralidoxime decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • pilocarpine ophthalmic

                pilocarpine ophthalmic increases and pralidoxime decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • pimozide

                pralidoxime decreases levels of pimozide by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

                pralidoxime decreases levels of pimozide by pharmacodynamic antagonism. Use Caution/Monitor.

                pimozide increases effects of pralidoxime by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

              • prochlorperazine

                pralidoxime decreases levels of prochlorperazine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

                pralidoxime decreases levels of prochlorperazine by pharmacodynamic antagonism. Use Caution/Monitor.

                prochlorperazine increases effects of pralidoxime by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

              • promethazine

                pralidoxime decreases levels of promethazine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

                pralidoxime decreases levels of promethazine by pharmacodynamic antagonism. Use Caution/Monitor.

                promethazine increases effects of pralidoxime by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

              • propantheline

                pralidoxime and propantheline both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • protriptyline

                pralidoxime and protriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • pyridostigmine

                pyridostigmine increases and pralidoxime decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • quetiapine

                pralidoxime decreases levels of quetiapine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

                pralidoxime decreases levels of quetiapine by pharmacodynamic antagonism. Use Caution/Monitor.

                quetiapine increases effects of pralidoxime by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

              • rapacuronium

                pralidoxime and rapacuronium both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • risperidone

                pralidoxime decreases levels of risperidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

                pralidoxime decreases levels of risperidone by pharmacodynamic antagonism. Use Caution/Monitor.

                risperidone increases effects of pralidoxime by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

              • rivastigmine

                rivastigmine increases and pralidoxime decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • rocuronium

                pralidoxime and rocuronium both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • scopolamine

                pralidoxime and scopolamine both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • solifenacin

                pralidoxime and solifenacin both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • succinylcholine

                succinylcholine increases and pralidoxime decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • thioridazine

                pralidoxime decreases levels of thioridazine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

                pralidoxime decreases levels of thioridazine by pharmacodynamic antagonism. Use Caution/Monitor.

                thioridazine increases effects of pralidoxime by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

              • thiothixene

                pralidoxime decreases levels of thiothixene by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

                pralidoxime decreases levels of thiothixene by pharmacodynamic antagonism. Use Caution/Monitor.

                thiothixene increases effects of pralidoxime by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

              • tiotropium

                pralidoxime and tiotropium both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • tolterodine

                pralidoxime and tolterodine both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • trazodone

                pralidoxime and trazodone both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • trifluoperazine

                pralidoxime decreases levels of trifluoperazine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

                pralidoxime decreases levels of trifluoperazine by pharmacodynamic antagonism. Use Caution/Monitor.

                trifluoperazine increases effects of pralidoxime by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

              • trimipramine

                pralidoxime and trimipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • trospium chloride

                pralidoxime and trospium chloride both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • vecuronium

                pralidoxime and vecuronium both decrease cholinergic effects/transmission. Use Caution/Monitor.

              • ziprasidone

                pralidoxime decreases levels of ziprasidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

                pralidoxime decreases levels of ziprasidone by pharmacodynamic antagonism. Use Caution/Monitor.

                ziprasidone increases effects of pralidoxime by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

              • zotepine

                pralidoxime decreases levels of zotepine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

                pralidoxime decreases levels of zotepine by pharmacodynamic antagonism. Use Caution/Monitor.

              Minor (3)

              • dimenhydrinate

                dimenhydrinate increases toxicity of pralidoxime by pharmacodynamic synergism. Minor/Significance Unknown. Additive anticholinergic effects.

              • donepezil

                donepezil decreases effects of pralidoxime by pharmacodynamic antagonism. Minor/Significance Unknown.

              • galantamine

                galantamine decreases effects of pralidoxime by pharmacodynamic antagonism. Minor/Significance Unknown.

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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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              Images

              BRAND FORM. UNIT PRICE PILL IMAGE
              Protopam Chloride injection
              -
              1 gram vial
              pralidoxime intramuscular
              -
              600 mg/2 mL injection

              Copyright © 2010 First DataBank, Inc.

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              Patient Handout

              Select a drug:
              Patient Education
              pralidoxime injection

              NO MONOGRAPH AVAILABLE AT THIS TIME

              USES: Consult your pharmacist.

              HOW TO USE: Consult your pharmacist.

              SIDE EFFECTS: Consult your pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

              PRECAUTIONS: Consult your pharmacist.

              DRUG INTERACTIONS: Consult your pharmacist.Keep a list of all your medications with you, and share the list with your doctor and pharmacist.

              OVERDOSE: If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center.

              NOTES: No monograph available at this time.

              MISSED DOSE: Consult your pharmacist.

              STORAGE: Consult your pharmacist.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company for more details about how to safely discard your product.

              Information last revised July 2016. Copyright(c) 2021 First Databank, Inc.

              IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.

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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.
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              Code Definition
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              Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.