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Pralidoxime

 
Drug Info: Pralidoxime

Brand names: Protopam®

Chemical formula:



Pralidoxime injection

What is pralidoxime injection?

PRALIDOXIME (Protopam®) treats poisoning by some insecticides (called organophosphates) and nerve agents, and overdoses of some medicines that treat myasthenia gravis. Generic pralidoxime injection is available. Emergency kits for injection are also available.

What should I tell my health care provider before I take this medicine?

They need to know if you have any of these conditions:
• kidney disease
• myasthenia gravis
• an unusual or allergic reaction to pralidoxime, other medicines, foods, dyes, o preservatives
• pregnant or trying to get pregnant
• breast-feeding

How should I use this medicine?

Pralidoxime is for injection into a muscle, under the skin, or into a vein. It is given by a health-care professional in a hospital or clinic setting. Pralidoxime is not for self-medication, except in emergency situations when it is possible that workers may be exposed to nerve agents or organophosphate insecticides. Injection kits are available for self-injection in case of emergency. Learn how and when to use the autoinjector before an emergency arises. If organophosphate poisoning occurs, atropine and pralidoxime are given as soon as possible. An atropine injection is given first and after the effects become apparent pralidoxime is given. Repeat the injections of atropine and pralidoxime after 15 minutes if symptoms continue, and again after an additional 15 minutes if symptoms persist. If symptoms of nerve agent exposure continue after the third set of injections, obtain medical help.

What if I miss a dose?

This does not apply.

What drug(s) may interact with pralidoxime?

atropine
• barbiturate medicines for inducing sleep or treating seizures (convulsions)
• medicines that improve muscle strength or tone for conditions like myasthenia gravis

Tell your prescriber or health care professional about all other medicines you are taking, including non-prescription medicines, nutritional supplements, or herbal products. Also tell your prescriber or health care professional if you are a frequent user of drinks with caffeine or alcohol, if you smoke, or if you use illegal drugs. These may affect the way your medicine works. Check with your health care professional before stopping or starting any of your medicines.

What should I watch for while taking pralidoxime?

Pralidoxime is not intended for long-term use. Contact your prescriber or health care professional immediately after an organophosphate or nerve agent poisoning occurs for instructions regarding treatment.

Remove contaminated clothing and wash the poison from the skin and hair.

What side effects may I notice from receiving pralidoxime?

Side effects may be difficult to distinguish from those caused by the poison.
Side effects that you should report to your prescriber or health care professional as soon as possible:
• hyperventilation (over breathing)
• muscle rigidity
• rapid heartbeat
• spasm of the larynx (voice box)

Side effects that usually do not require medical attention (report to your prescriber or health care professional if they continue or are bothersome):
• blurred or double vision
• dizziness, drowsiness
• excitement, agitation, or manic behavior
• headache
• muscle weakness
• nausea, vomiting
• skin rash

Where can I keep my medicine?

Keep out of the reach of children.

Store at room temperature, approximately 25 degrees C (77 degrees F). Throw away any unused medicine after the expiration date.


Last updated: 7/1/2002

Important Disclaimer: The drug information provided here is for educational purposes only. It is intended to supplement, not substitute for, the diagnosis, treatment and advice of a medical professional. This drug information does not cover all possible uses, precautions, side effects and interactions. It should not be construed to indicate that this or any drug is safe for you. Consult your medical professional for guidance before using any prescription or over the counter drugs.

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Veterinary Dictionary: pralidoxime
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A cholinesterase reactivator, effective against the nicotinic cholinergic effects of organophosphorus compounds; it also has limited value in counteracting carbamate-type cholinesterase inhibitors; abbreviated 2-PAM.

Wikipedia: Pralidoxime
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Pralidoxime
Systematic (IUPAC) name
2-[(hydroxyimino)methyl]-1-methylpyridin-1-ium
Identifiers
CAS number 6735-59-7
ATC code V03AB04
PubChem 5353894
DrugBank APRD01193
Chemical data
Formula C7H9N2O+
Mol. mass 137.159 g/mol
Synonyms 1-methylpyridine-6-carbaldehyde oxime
Pharmacokinetic data
Bioavailability  ?
Metabolism  ?
Half life  ?
Excretion  ?
Therapeutic considerations
Pregnancy cat.

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Legal status
Routes  ?
 Yes check.svgY(what is this?)  (verify)

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).

Contents

Mechanism of action

Pralidoxime reversibly binds to the enzyme acetylcholinesterase, competing with organophosphate binding. However, 2-PAM does not inactivate the enzyme and is therefore thought to dislodge or block organophosphates from inactivating acetylcholinesterase. However, organophosphates ultimately irreversibly bind to acetylcholinesterase, requiring early administration of 2-PAM. Note that meta-analyses of the use of "-oximes" (like 2-PAM) in organophosphate poisoning have not demonstrated any benefit (and their use may be harmful). There are no controlled studies.

Dosage

Recommended dosages, according to online sources, seem to be:[citation needed]

  • Adults: 30 mg/kg (Typically 600 mg - 2 g), administered either by intravenous therapy or intramuscular injection, possibly repeated 15 to 60 minutes later till the maximum dose is reached
  • Children: 50 mg/kg

Interactions

When atropine and pralidoxime are used together, the signs of atropinization (flushing, mydriasis, tachycardia, dryness of the mouth and nose) may occur earlier than might be expected when atropine is used alone. This is especially true if the total dose of atropine has been large and the administration of pralidoxime has been delayed.

The following precautions should be kept in mind in the treatment of anticholinesterase poisoning, although they do not bear directly on the use of pralidoxime: since barbiturates are potentiated by the anticholinesterases, they should be used cautiously in the treatment of convulsions; morphine, theophylline, aminophylline, succinylcholine, reserpine, and phenothiazine-type tranquilizers should be avoided in patients with organophosphate poisoning.

Contraindications

There are no known absolute contraindications for the use of pralidoxime. Relative contraindications include known hypersensitivity to the drug and other situations in which the risk of its use clearly outweighs possible benefit.

See also

External links


 
 
Learn More
PAM, 2-PAM
Pralidoxime injection
Insecticide Poisoning: Treatment

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Copyrights:

Drug Info. Gold Standard. Copyright © 2008 by Gold Standard. All rights reserved.  Read more
Veterinary Dictionary. Saunders Comprehensive Veterinary Dictionary 3rd Edition. Copyright © 2007 by D.C. Blood, V.P. Studdert and C.C. Gay, Elsevier. All rights reserved.  Read more
Wikipedia. This article is licensed under the Creative Commons Attribution/Share-Alike License. It uses material from the Wikipedia article "Pralidoxime" Read more