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Pralidoxime information from DrugsUpdate  

See Available Brands of Pralidoxime in India

P - Caution when used during pregnancy
L - Caution when used during lactation
LI - Lab *

Pralidoxime belongs to a family of compounds called oximes that bind to organophosphate-inactivated acetylcholinesterase. It is used to combat poisoning by organophosphates or acetylcholinesterase inhibitors (nerve agents), in conjunction with atropine and diazepam. Pralidoxime is most commonly in the form of Pralidoxime Chloride, also known as 2-PAM Cl (or just 2-PAM by the military). As the iodide salt (methiodide), it is also called pyridine aldoximine methiodide or pyridine aldoxime methiodide (PAM).

Pharmacodynamics

Pharmacokinetics

Pralidoxime reactivates cholinesterase outside the CNS which has been inactivated by phosphorylation due to organophosphate pesticide exposure-resulting. This leads to the destruction of acetylcholine at the neuromuscular junction thus relieving muscle paralysis. It also removes the phosphyl group from the active site of inactivated enzyme which is dependent on the nature of the phosphyl group.

Distribution
Not bound and does not readily penetrate the CNS.

Excretion
Via urine (rapid; as unchanged and partly as metabolites); 1-3 hours (elimination half-life).

Pralidoxime Indications / Pralidoxime Uses

Information Not Available

Pralidoxime Adverse Reactions / Pralidoxime Side Effects

Drowsiness, dizziness, visual disturbances, nausea, tachycardia, headache, hyperventilation and muscle weakness.

Potentially Fatal: Rapid admin causes tachycardia, laryngospasm and rigidity. Large doses cause neuromuscular blockade.

Precautions

Pralidoxime has been very well tolerated in most cases, but it must be remembered that the desperate condition of the organophosphate-poisoned patient will generally mask such minor signs and symptoms as have been noted in normal subjects.

Because pralidoxime is excreted in the urine, a decrease in renal function will result in increased blood levels of the drug. Thus, the dosage of pralidoxime should be reduced in the presence of renal insufficiency.

Special Precautions

Renal dysfunction, myasthenia gravis. Atropinisation may occur faster when atropine and pralidoxime are used together. Pregnancy, lactation.

Other Drug Interactions

Information Not Available

Other Interactions

Information Not Available

Dosage

Parenteral
Organophosphorus poisoning
Adult: Used in combination with atropine. Admin atropine via IM/IV injection and repeat as needed until patient shows signs of atropine toxicity. Maintain atropinisation for at least 48 hours. As soon as the effects of atropine are observed, 1-2 g of pralidoxime (chloride, iodide or mesilate) may be given via IM/IV injection. Repeat dose after 1 hour, then every 8-12 hours, if necessary. In severe poisoning, continuous infusion of 200-500 mg/hours may be given, titrated according to response. Alternatively, pralidoxime chloride may be given at an initial dose of 30 mg/kg via IV infusion over 20 minutes or IV injection over 5 minutes, followed by IV infusion at 8 mg/kg/hours. Max: 12 g/24 hours.
Child: As mesilate: 20-60 mg/kg.
Renal impairment: Dose adjustment may be required.

Food(before/after)

Information Not Available

List of Contraindications

Pralidoxime and Pregnancy

Caution when used during pregnancy

Pralidoxime and Lactation

Caution when used during lactation

Pralidoxime and Children

Information Not Available

Pralidoxime and Geriatic

Information Not Available

Pralidoxime and Other Contraindications

Carbamate pesticide poisoning, hypersensitivity.

Storage

Parenteral
Store at 20-25°C

Lab interference

Parenteral
Store at 20-25°C

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