Pralidoxime (Protopam)

Category:

Nervous system

Description:

Anticholinesterase antidote

Indications:

Antidote in poisonings due to organophosphate pesticides and related compounds
Control of overdose by anticholinesterase drugs used to treat myasthenia gravis

Precautions:

Pregnancy category C
Rapid IV injection, impaired renal function
Myasthenia gravis, carbamate poisoning (less effective than with organophosphate poisoning)

Adverse Reactions (Side Effects):

CNS: dizziness, drowsiness, headache
CV: tachycardia
EENT: blurred vision, diplopia, impaired accommodation
GI: transaminase elevations, nausea
MS: muscular weakness
RESP: hyperventilation
SKIN: pain at injection site (IM)

Dosage:

Administered intramuscularly, intravenously

Adult:
- Organophosphate poisoning:
  - IM/IV 1-2g, repeat in 1-2 hours if muscle weakness has not resolved, then at 10-12 hour intervals in cholinergic signs reappear
- Anticholinesterase overdose:
  - IV 1-2g followed by 250mg every 5 minutes until desired response
Child:
- Organophosphate poisoning:
  - IM/IV 20-50 mg/kg/dose, repeat in 1-2 hours if muscle weakness has not resolved, then at 10-12 hour intervals if cholinergic signs reappear

Source: Operational Medicine 2001, Health Care in Military Settings, NAVMED P-5139, May 1, 2001, Bureau of Medicine and Surgery, Department of the Navy, 2300 E Street NW, Washington, D.C., 20372-5300