Pralidoxime

Aliases: 2-PAM, Protopam 

Indications: Organophosphate Toxidrome         

Contraindications: Documented hypersensitivity 

Concentrations: 

Injection: 300mg/mL

Dosing

Adult:

Indication	Dose	Route	Note
Organophosphate Toxidrome/Nerve Gas Exposure	600 mg	IM	-Use in an autoinjector. -Repeat PRN until symptoms resolve.

Pediatric:

Indication	Dose	Route	Note
Organophosphate Toxidrome/Nerve Gas Exposure	600 mg	IM	-Use in an autoinjector. -Repeat PRN until symptoms resolve.

Precautions:  Pregnancy class C. May precipitate myasthenia crisis.   

Adverse/Side Effects: Laryngospasm, Muscle paralysis, Hypertension, Sinus tachycardia, Mania. 

Class: Cholinesterase reactivator 

Mechanism of Action: Pralidoxime is a cholinesterase reactivator that reverses muscle paralysis after organophosphate poisoning. Organophosphate compounds inhibit cholinesterase via phosphorylation of the enzyme. The inhibited cholinesterase is unable to metabolize acetylcholine resulting in an accumulation of the neurotransmitter. Acetylcholine is present in the central nervous system, parts of the autonomic nervous system, and at the skeletal muscle end plates; therefore, accumulation of this neurotransmitter after organophosphate poisoning adversely affects each of these systems. In the somatic nervous system, acetylcholine accumulation leads to paralysis. The clinical effects of pralidoxime are most evident at skeletal neuromuscular junctions. Pralidoxime reverses the paralysis by removing the phosphoryl group from the inhibited cholinesterase molecule, reactivating the enzyme, and restoring the body’s ability to metabolize acetylcholine.   

Onset of Action	Peak Effect	Duration of Action
Few minutes	5-15 minutes	75 minutes