Pralidoxime Chloride
2-PAM, Protopam
Class:
Cholinestrase reactivator.
Cholinestrase reactivator.
Mechanism of Action:
Reactivation of cholinestrase to effectively act as an antidote to organophosphate pesticide poisoning. This action allows for destruction of accumulated acetylcholine at the neuromuscular junction.
Reactivation of cholinestrase to effectively act as an antidote to organophosphate pesticide poisoning. This action allows for destruction of accumulated acetylcholine at the neuromuscular junction.
Indications:
As an antidote in the treatment of poisoning by organophosphate pesticides and chemicals. In the prehospital arena, is used when atropine is or has become ineffective in management of organophosphate poisoning.
As an antidote in the treatment of poisoning by organophosphate pesticides and chemicals. In the prehospital arena, is used when atropine is or has become ineffective in management of organophosphate poisoning.
Contraindications:
- Use with caution in patients with reduced renal function.
- Patients with myasthenia gravis and organophosphate poisoning.
Adverse reactions:
Dizziness, blurred vision, diplopia, headache, drowsiness, nausea, tachycardia, hyperventilation, muscular weakness, excitement and manic behavior.
Dizziness, blurred vision, diplopia, headache, drowsiness, nausea, tachycardia, hyperventilation, muscular weakness, excitement and manic behavior.
Drug Interactions
No direct drug interactions, however, patients with organophosphate poisoning should not be given barbituates, morphine, theophylline, aminophylline, succinylcholine, reserpine and phenothiazines.
No direct drug interactions, however, patients with organophosphate poisoning should not be given barbituates, morphine, theophylline, aminophylline, succinylcholine, reserpine and phenothiazines.
Adult Dosage and Administration
Note: If Protopam is to be used, administer almost simultaneously with atropine.
Intial dose 1-2 grams as an IV infusion with 100 ml NS over 15-30 minutes.
Doses may be repeated every hour if muscle weakness persists.
If IV administration is not feasible, IM or SC injection may be utilized.
Note: If Protopam is to be used, administer almost simultaneously with atropine.
Intial dose 1-2 grams as an IV infusion with 100 ml NS over 15-30 minutes.
Doses may be repeated every hour if muscle weakness persists.
If IV administration is not feasible, IM or SC injection may be utilized.
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Pediatric Dosage and Administration:Note: If Protopam is to be used, administer almost simultaneously with atropine.
20-40 mg/kg as IV infusion over 15-30 minutes.
Doses may be repeated every hour if muscle weakness persists.
If IV administration is not feasible, IM or SC injection may be utilized.
Duration of Action
- Onset: Minutes.
- Peak effect: Variable.
- Duration: Variable.
Special Considerations:
- Pregnancy Safety: unknown.
- Treatment will be most effective if given within a few hours after poisoning.
- Cardiac monitoring should be considered in all cases of sever organophosphate poisoning.