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")
Comments
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 |