Pralidoxime

General

• Also known as 2-PAM
• Type: Antidote
• Dosage Forms:
• Common Trade Names: Protopam

Adult Dosing

Organophosphate toxicity

• 1-2gm IV over 5-10min
• Continuous infusion of 500mg/hr if no initial response

Pediatric Dosing

Organophosphate toxicity

• 20-40mg/kg (up to 1gm) IV over 5-10min
• 5-10mg/kg/hr if no initial response

Special Populations

• Pregnancy Rating: C
• Lactation risk: Unknown
• Renal Dosing
  • Adult - no requirements from manufacturer, but given that it is excreted in the urine dosage reduction is recommended.
  • Pediatric
• Hepatic Dosing
  • Adult - no adjustments recommended by manufacturer.
  • Pediatric

Contraindications

• Allergy to class/drug

Adverse Reactions

Serious

• Laryngospasm
• Myasthenic crisis in patients with Myasthenia gravis
• Hepatitis

Common

• Blurry vision
• Diplopia
• Nausea
• Tachycardia
• Hypertension

Pharmacology

• Half-life: Apparent: 74 to 77 minutes, IM/IV exposure: 3 to 4 hours
• Metabolism: Hepatic
• Excretion: Urine
• Mechanism of Action: Displaces an organophosphate from acetylcholinesterase (if given early before irreversible enzyme binding occurs, aka "aging")

Indications by Condition

The following table is automatically generated from disease/condition pages across WikEM.

Indication	Dose	Context	Route	Population
Carbamate poisoning	20mg/kg (max 2g) IV over 30min, then 8-10mg/kg/hr (max 650mg/hr)	Only if unknown agent or mixed OP/carbamate exposure	IV	Adult
Carbamate toxicity	1-2 g IV over 15-30 min, then 8-10 mg/kg/hr infusion (or repeat bolus in 1 hr)	Cholinergic toxicity (oxime reactivator)	IV	Adult
Carbamate toxicity	20-50 mg/kg IV, then 5-10 mg/kg/hr infusion	Cholinergic toxicity (oxime reactivator)	IV	Pediatric
Cholinergic crisis	20mg/kg (max 2g) IV over 30min, then 8-10mg/kg/hr (max 650mg/hr)	Cholinesterase reactivator	IV	Adult
Electronic cigarettes	1-2 g IV over 15-30 min, then 8-10 mg/kg/hr infusion (or repeat bolus in 1 hr)	Cholinergic toxicity (oxime reactivator)	IV	Adult
Electronic cigarettes	20-50 mg/kg IV, then 5-10 mg/kg/hr infusion	Cholinergic toxicity (oxime reactivator)	IV	Pediatric
Nicotine toxicity	1-2 g IV over 15-30 min, then 8-10 mg/kg/hr infusion (or repeat bolus in 1 hr)	Cholinergic toxicity (oxime reactivator)	IV	Adult
Nicotine toxicity	20-50 mg/kg IV, then 5-10 mg/kg/hr infusion	Cholinergic toxicity (oxime reactivator)	IV	Pediatric
Organophosphate toxicity	1-2 g over 15-30 min, then 500 mg/hr infusion	Oxime (AChE reactivator)	IV	Adult
Organophosphate toxicity	20-50 mg/kg, then 5-10 mg/kg/hr infusion	Oxime (AChE reactivator)	IV	Pediatric
Organophosphate toxicity	1-2 g IV over 15-30 min, then 8-10 mg/kg/hr infusion (or repeat bolus in 1 hr)	Cholinergic toxicity (oxime reactivator)	IV	Adult
Organophosphate toxicity	20-50 mg/kg IV, then 5-10 mg/kg/hr infusion	Cholinergic toxicity (oxime reactivator)	IV	Pediatric

See Also

Organophosphate Toxicity