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

• Tachycardia
• Hypertension
• Laryngospasm
• Hepatitis

Common

• 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")

See Also

Organophosphate Toxicity