Dosing & Uses
Dosage Forms & Strengths
powder for reconstitution
- 1g/vial
injection solution
- 300 mg/mL
Organophosphate Poisoning
1-2 g IV infusion (10-20 mg/mL) over 15-30 min, repeat in 1 hr if necessary and repeat q12hr thereafter PRN; if not practical or if pulmonary edema present or fluid restriction necessary administer as 50 mg/mL over 5 min; a second bolus of 1-2 g may be indicated after about 1 hr if muscle weakness has not been relieved; may repeat q10-12hr prn
Alternatively, administer 30 mg/kg IV (IM, SC if no IV access) over 20 min; follow by 4-8 mg/kg/hr maintenance IV infusion
Use with atropine, which affects muscarinic receptors; pralidoxime's actions most striking at nicotonic sites (increase muscle strength 10-40 min)
IM: 600 mg IM x3 doses; administer each dose 15 minutes apart for mild symptoms, or in rapid succession for severe symptoms; not to exceed 1800 mg total dose initially; if symptoms persist may repeat series of three injections 1 hr after last injection
Acetylcholinesterase Inhibitor Toxicity (Neostigmine, Pyridostigmine)
1-2 g IV followed by 250 mg increments q5min PRN
Renal Impairment
Reduce dose; no specific recommendations provided by manufacturer
Dosage Forms & Strengths
powder for reconstitution
- 1g/vial
injection solution
- 300 mg/mL
Organophosphate Poisoning
< 16 years
- 20-50 mg/kg/dose (not to exceed 2 g/dose) IV; follow by 10-20 mg/kg/hr IV continuous infusion for maintenance; alternatively may repeat bolus of 20-50 mg/kg/dose over 1 hr and repeat q10-12hr if muscle weakness has not bee relieved
> 16 years
- 1-2 g IV infusion (10-20 mg/mL) over 15-30 min, repeat in 1 hr if necessary and repeat q12hr thereafter PRN; if not practical or if pulmonary edema present or fluid restriction necessary administer as 50 mg/mL over 5 min; a second bolus of 1-2 g may be indicated after about 1 hr if muscle weakness has not been relieved; may repeat q10-12hr prn
- Alternatively, administer 30 mg/kg IV (IM, SC if no IV access) over 20 min; follow by 4-8 mg/kg/hr maintenance IV infusion
IM administration
- <40 kg: 15 mg/kg/dose IM x3 doses administered q15min for mild symptoms; not to exceed 45 mg/kg or in rapid succession for severe symptoms
- >40 kg or greater: 600 mg IM x3 doses; administer each dose 15 minutes apart for mild symptoms, or in rapid succession for severe symptoms; not to exceed 1800 mg total dose initially
- If symptoms persist may repeat series of three injections 1 hr after last injection
- Administer in the anterolateral aspect of the thigh to avoid the nerve, artery and vein, as well as the femur
Administer with caution; consider possibility of decreased renal, hepatic, and renal function
Interactions
Interaction Checker
No Results
Contraindicated
Serious - Use Alternative
Significant - Monitor Closely
Minor
Contraindicated (0)
Serious - Use Alternative (1)
- pramlintide
pramlintide, pralidoxime. Either increases effects of the other by pharmacodynamic synergism. Contraindicated. Synergistic inhibition of GI motility.
Monitor Closely (89)
- aclidinium
pralidoxime and aclidinium both decrease cholinergic effects/transmission. Use Caution/Monitor.
- amitriptyline
pralidoxime and amitriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.
- amoxapine
pralidoxime and amoxapine both decrease cholinergic effects/transmission. Use Caution/Monitor.
- anticholinergic/sedative combos
anticholinergic/sedative combos and pralidoxime both decrease cholinergic effects/transmission. Use Caution/Monitor.
- aripiprazole
pralidoxime decreases levels of aripiprazole by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
pralidoxime decreases levels of aripiprazole by pharmacodynamic antagonism. Use Caution/Monitor.
aripiprazole increases effects of pralidoxime by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia. - atracurium
atracurium and pralidoxime both decrease cholinergic effects/transmission. Use Caution/Monitor.
- atropine
atropine and pralidoxime both decrease cholinergic effects/transmission. Use Caution/Monitor.
- atropine IV/IM
atropine IV/IM and pralidoxime both decrease cholinergic effects/transmission. Use Caution/Monitor.
- belladonna alkaloids
belladonna alkaloids and pralidoxime both decrease cholinergic effects/transmission. Use Caution/Monitor.
- belladonna and opium
belladonna and opium and pralidoxime both decrease cholinergic effects/transmission. Use Caution/Monitor.
- benperidol
pralidoxime decreases levels of benperidol by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
pralidoxime decreases levels of benperidol by pharmacodynamic antagonism. Use Caution/Monitor.
benperidol increases effects of pralidoxime by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia. - benztropine
benztropine and pralidoxime both decrease cholinergic effects/transmission. Use Caution/Monitor.
- bethanechol
bethanechol increases and pralidoxime decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- carbachol
carbachol increases and pralidoxime decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- cevimeline
cevimeline increases and pralidoxime decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- chlorpromazine
pralidoxime decreases levels of chlorpromazine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
pralidoxime decreases levels of chlorpromazine by pharmacodynamic antagonism. Use Caution/Monitor.
chlorpromazine increases effects of pralidoxime by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia. - cisatracurium
cisatracurium and pralidoxime both decrease cholinergic effects/transmission. Use Caution/Monitor.
- clomipramine
pralidoxime and clomipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.
- clozapine
pralidoxime decreases levels of clozapine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
pralidoxime decreases levels of clozapine by pharmacodynamic antagonism. Use Caution/Monitor.
clozapine increases effects of pralidoxime by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia. - cyclizine
cyclizine and pralidoxime both decrease cholinergic effects/transmission. Use Caution/Monitor.
- cyclobenzaprine
cyclobenzaprine and pralidoxime both decrease cholinergic effects/transmission. Use Caution/Monitor.
- darifenacin
darifenacin and pralidoxime both decrease cholinergic effects/transmission. Use Caution/Monitor.
- desipramine
pralidoxime and desipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.
- dicyclomine
dicyclomine and pralidoxime both decrease cholinergic effects/transmission. Use Caution/Monitor.
- diphenhydramine
diphenhydramine and pralidoxime both decrease cholinergic effects/transmission. Use Caution/Monitor.
- donepezil
donepezil increases and pralidoxime decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- dosulepin
pralidoxime and dosulepin both decrease cholinergic effects/transmission. Use Caution/Monitor.
- doxepin
pralidoxime and doxepin both decrease cholinergic effects/transmission. Use Caution/Monitor.
- droperidol
pralidoxime decreases levels of droperidol by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
pralidoxime decreases levels of droperidol by pharmacodynamic antagonism. Use Caution/Monitor.
droperidol increases effects of pralidoxime by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia. - echothiophate iodide
echothiophate iodide increases and pralidoxime decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- fesoterodine
fesoterodine and pralidoxime both decrease cholinergic effects/transmission. Use Caution/Monitor.
- flavoxate
flavoxate and pralidoxime both decrease cholinergic effects/transmission. Use Caution/Monitor.
- fluphenazine
pralidoxime decreases levels of fluphenazine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
pralidoxime decreases levels of fluphenazine by pharmacodynamic antagonism. Use Caution/Monitor.
fluphenazine increases effects of pralidoxime by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia. - galantamine
galantamine increases and pralidoxime decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- glycopyrrolate
glycopyrrolate and pralidoxime both decrease cholinergic effects/transmission. Use Caution/Monitor.
- glycopyrrolate inhaled
glycopyrrolate inhaled and pralidoxime both decrease cholinergic effects/transmission. Use Caution/Monitor.
- haloperidol
pralidoxime decreases levels of haloperidol by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
pralidoxime decreases levels of haloperidol by pharmacodynamic antagonism. Use Caution/Monitor.
haloperidol increases effects of pralidoxime by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia. - henbane
henbane and pralidoxime both decrease cholinergic effects/transmission. Use Caution/Monitor.
- homatropine
homatropine and pralidoxime both decrease cholinergic effects/transmission. Use Caution/Monitor.
- huperzine A
huperzine A increases and pralidoxime decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- hyoscyamine
hyoscyamine and pralidoxime both decrease cholinergic effects/transmission. Use Caution/Monitor.
- hyoscyamine spray
hyoscyamine spray and pralidoxime both decrease cholinergic effects/transmission. Use Caution/Monitor.
- iloperidone
pralidoxime decreases levels of iloperidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
pralidoxime decreases levels of iloperidone by pharmacodynamic antagonism. Use Caution/Monitor.
iloperidone increases effects of pralidoxime by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia. - imipramine
pralidoxime and imipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.
- ipratropium
ipratropium and pralidoxime both decrease cholinergic effects/transmission. Use Caution/Monitor. Due to the poor systemic absorption of ipratropium, interaction unlikely at regularly recommended dosages.
- lofepramine
pralidoxime and lofepramine both decrease cholinergic effects/transmission. Use Caution/Monitor.
- loxapine
pralidoxime decreases levels of loxapine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
pralidoxime decreases levels of loxapine by pharmacodynamic antagonism. Use Caution/Monitor.
loxapine increases effects of pralidoxime by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia. - loxapine inhaled
loxapine inhaled increases effects of pralidoxime by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.
pralidoxime decreases levels of loxapine inhaled by pharmacodynamic antagonism. Use Caution/Monitor. - maprotiline
pralidoxime and maprotiline both decrease cholinergic effects/transmission. Use Caution/Monitor.
- meclizine
meclizine and pralidoxime both decrease cholinergic effects/transmission. Use Caution/Monitor.
- methscopolamine
methscopolamine and pralidoxime both decrease cholinergic effects/transmission. Use Caution/Monitor.
- neostigmine
neostigmine increases and pralidoxime decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- nortriptyline
pralidoxime and nortriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.
- olanzapine
pralidoxime decreases levels of olanzapine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
pralidoxime decreases levels of olanzapine by pharmacodynamic antagonism. Use Caution/Monitor.
olanzapine increases effects of pralidoxime by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia. - onabotulinumtoxinA
onabotulinumtoxinA and pralidoxime both decrease cholinergic effects/transmission. Use Caution/Monitor.
- orphenadrine
pralidoxime and orphenadrine both decrease cholinergic effects/transmission. Use Caution/Monitor.
- oxybutynin
oxybutynin and pralidoxime both decrease cholinergic effects/transmission. Use Caution/Monitor.
- oxybutynin topical
oxybutynin topical and pralidoxime both decrease cholinergic effects/transmission. Use Caution/Monitor.
- oxybutynin transdermal
oxybutynin transdermal and pralidoxime both decrease cholinergic effects/transmission. Use Caution/Monitor.
- paliperidone
pralidoxime decreases levels of paliperidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
pralidoxime decreases levels of paliperidone by pharmacodynamic antagonism. Use Caution/Monitor.
paliperidone increases effects of pralidoxime by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia. - pancuronium
pancuronium and pralidoxime both decrease cholinergic effects/transmission. Use Caution/Monitor.
- perphenazine
pralidoxime decreases levels of perphenazine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
pralidoxime decreases levels of perphenazine by pharmacodynamic antagonism. Use Caution/Monitor.
perphenazine increases effects of pralidoxime by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia. - physostigmine
physostigmine increases and pralidoxime decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- pilocarpine
pilocarpine increases and pralidoxime decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- pimozide
pralidoxime decreases levels of pimozide by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
pralidoxime decreases levels of pimozide by pharmacodynamic antagonism. Use Caution/Monitor.
pimozide increases effects of pralidoxime by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia. - prochlorperazine
pralidoxime decreases levels of prochlorperazine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
pralidoxime decreases levels of prochlorperazine by pharmacodynamic antagonism. Use Caution/Monitor.
prochlorperazine increases effects of pralidoxime by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia. - promethazine
pralidoxime decreases levels of promethazine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
pralidoxime decreases levels of promethazine by pharmacodynamic antagonism. Use Caution/Monitor.
promethazine increases effects of pralidoxime by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia. - propantheline
pralidoxime and propantheline both decrease cholinergic effects/transmission. Use Caution/Monitor.
- protriptyline
pralidoxime and protriptyline both decrease cholinergic effects/transmission. Use Caution/Monitor.
- pyridostigmine
pyridostigmine increases and pralidoxime decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- quetiapine
pralidoxime decreases levels of quetiapine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
pralidoxime decreases levels of quetiapine by pharmacodynamic antagonism. Use Caution/Monitor.
quetiapine increases effects of pralidoxime by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia. - rapacuronium
pralidoxime and rapacuronium both decrease cholinergic effects/transmission. Use Caution/Monitor.
- risperidone
pralidoxime decreases levels of risperidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
pralidoxime decreases levels of risperidone by pharmacodynamic antagonism. Use Caution/Monitor.
risperidone increases effects of pralidoxime by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia. - rivastigmine
rivastigmine increases and pralidoxime decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- rocuronium
pralidoxime and rocuronium both decrease cholinergic effects/transmission. Use Caution/Monitor.
- scopolamine
pralidoxime and scopolamine both decrease cholinergic effects/transmission. Use Caution/Monitor.
- solifenacin
pralidoxime and solifenacin both decrease cholinergic effects/transmission. Use Caution/Monitor.
- succinylcholine
succinylcholine increases and pralidoxime decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- thioridazine
pralidoxime decreases levels of thioridazine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
pralidoxime decreases levels of thioridazine by pharmacodynamic antagonism. Use Caution/Monitor.
thioridazine increases effects of pralidoxime by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia. - thiothixene
pralidoxime decreases levels of thiothixene by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
pralidoxime decreases levels of thiothixene by pharmacodynamic antagonism. Use Caution/Monitor.
thiothixene increases effects of pralidoxime by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia. - tiotropium
pralidoxime and tiotropium both decrease cholinergic effects/transmission. Use Caution/Monitor.
- tolterodine
pralidoxime and tolterodine both decrease cholinergic effects/transmission. Use Caution/Monitor.
- trazodone
pralidoxime and trazodone both decrease cholinergic effects/transmission. Use Caution/Monitor.
- trifluoperazine
pralidoxime decreases levels of trifluoperazine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
pralidoxime decreases levels of trifluoperazine by pharmacodynamic antagonism. Use Caution/Monitor.
trifluoperazine increases effects of pralidoxime by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia. - trimipramine
pralidoxime and trimipramine both decrease cholinergic effects/transmission. Use Caution/Monitor.
- trospium chloride
pralidoxime and trospium chloride both decrease cholinergic effects/transmission. Use Caution/Monitor.
- vecuronium
pralidoxime and vecuronium both decrease cholinergic effects/transmission. Use Caution/Monitor.
- ziprasidone
pralidoxime decreases levels of ziprasidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
pralidoxime decreases levels of ziprasidone by pharmacodynamic antagonism. Use Caution/Monitor.
ziprasidone increases effects of pralidoxime by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia. - zotepine
pralidoxime decreases levels of zotepine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
pralidoxime decreases levels of zotepine by pharmacodynamic antagonism. Use Caution/Monitor.
Minor (3)
- dimenhydrinate
dimenhydrinate increases toxicity of pralidoxime by pharmacodynamic synergism. Minor/Significance Unknown. Additive anticholinergic effects.
- donepezil
donepezil decreases effects of pralidoxime by pharmacodynamic antagonism. Minor/Significance Unknown.
- galantamine
galantamine decreases effects of pralidoxime by pharmacodynamic antagonism. Minor/Significance Unknown.
Adverse Effects
Frequency Not Defined
Pain at site
Transient dizziness
Blurred vision
Double vision
Dizziness
Hypertension
Tachycardia
Cardiac arrest
Laryngospasm
Muscle rigidity
ALT (transient increase); AST (transient increase)
Respiratory/cardiac arrest if given too fast IV
Headache
Seizure
Drowsiness
Nausea
Warnings
Contraindications
None for the approved indications
Cautions
Administer concomitant atropine
Not approved for the treatment of carabamate poisoning
Not indicated for poisoning resulting from inorganic phosphates, phosphorus, or organophosphates that do not involve anticholinesterase activity
Use caution in myasthenia gravis (may presipitate myasthenia crisis)
Not equally active against all organophosphates
Give IM if patient is cyanotic
Observe patients for at least 24 hr
Pregnancy & Lactation
Pregnancy Category: C
Pregnancy Categories
A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.
B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk. C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done. D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk. X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist. NA: Information not available.Pharmacology
Mechanism of Action
Binds to organophosphates and breaks alkyl phosphate-cholinesterase bond to restore activity of acetylcholinesterase
Pharmacokinetics
Onset: 5-15 min
Vd: 0.6-2.7 L/kg (may increase in severe organophosphate intoxication)
Protein binding: None
Metabolism: Hepatic
Half-life: 3-4 hr (IM, IV)
Excretion: 80%
Administration
IV Preparation
Reconstitute by adding 20 mL SWI to the 1 g vial to provide a 50 mg/mL solution (do not use preservative-containing solutions)
Use within a few hours
IV Administration
For infusion, dilute required amount of reconstituted solution to 100 mL with NS
Infuse over 15-30 min
May also be given as 5 min slow IVP
IM Administration
1 g vial contents may be reconstituted by adding 3 mL SWI or NS to provide a 300 mg/mL solution
Images
| BRAND | FORM. | UNIT PRICE | PILL IMAGE |
|---|---|---|---|
| pralidoxime intramuscular - | 600 mg/2 mL injection |  | |
| Protopam Chloride injection - | 1 gram vial |  |
Copyright © 2010 First DataBank, Inc.
Patient Handout
pralidoxime intramuscular
PRALIDOXIME AUTO-INJECTOR - INJECTION
(PRAL-i-DOX-eem)
USES: This medication is used with atropine to treat nerve agent poisoning by certain chemicals known as anticholinesterase agents (such as organophosphate pesticides such as parathion, "nerve gas" such as sarin, other nerve agents such as VX). Pralidoxime works by restoring the activity of a certain natural substance (cholinesterase) needed by nerves and muscles. Symptoms of nerve agent poisoning may include trouble breathing, headache, runny nose, drooling, vision changes, sweating, abdominal cramps, nausea, vomiting, diarrhea, muscle twitching/jerking, drowsiness, confusion, and seizures.Pralidoxime works mostly on the muscles (including breathing muscles) to decrease twitching, cramping, weakness, and paralysis. Another medication (atropine) is used to treat these and other symptoms of nerve agent poisoning such as slow/shallow breathing, wheezing, increased sweating/saliva, abdominal cramps, vomiting, and diarrhea.
HOW TO USE: Talk with your doctor about when you should use this product. Know the symptoms of nerve agent poisoning. (See also Uses section.)Learn how to properly inject this medication in advance so you will be prepared if you actually need to use it. Also teach another person what to do in case you cannot inject the medication yourself.This medication is given by injection into the muscle of the outer thigh, through clothing if necessary, as soon as possible after exposure to a nerve agent. Another drug (atropine) is usually injected first. Inject this drug (pralidoxime) after the atropine. Hold the injector firmly in place for 10 seconds. Massage the area of injection.To prevent further exposure to poison, the victim (and any others who treat or have contact with the victim) must right away put on protective equipment (such as breathing mask, gloves) and perform rapid decontamination procedures (such as removing contaminated clothing, washing skin and hair with sodium bicarbonate or alcohol).Pralidoxime is most effective when used within 24 hours after exposure. If symptoms of poisoning (such as increase in saliva, difficulty breathing, muscle weakness) are still present 15 minutes after the injections, you may give another dose of both atropine and pralidoxime. If needed, you may give a third set of injections 15 minutes later.Get medical help right away for follow-up treatment. Do not give more than 3 injections unless directed by a doctor.Dosage is based on your medical condition and poisoning symptoms.
SIDE EFFECTS: Dizziness, drowsiness, or pain at the injection site may occur. Normal effects from atropine include flushing, large pupils, fast heartbeat, and dryness of the mouth and nose. If any of these effects last or get worse, tell your doctor, pharmacist, or other health care professional promptly.Remember that this medication has been prescribed because your doctor has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), worsening dizziness, worsening trouble breathing.This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.
PRECAUTIONS: Before using pralidoxime, tell your doctor or pharmacist if you are allergic to it; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.Before using this medication, tell your doctor or pharmacist your medical history, especially of: kidney disease, a certain nerve/muscle problem (myasthenia gravis).This drug may make you dizzy or drowsy. Alcohol or marijuana (cannabis) can make you more dizzy or drowsy. Do not drive, use machinery, or do anything that needs alertness until you can do it safely. Avoid alcoholic beverages. Talk to your doctor if you are using marijuana (cannabis).During pregnancy, this medication should be used only when clearly needed. Discuss the risks and benefits with your doctor.It is unknown if this drug passes into breast milk. Consult your doctor before breast-feeding.
DRUG INTERACTIONS: Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.
OVERDOSE: If this drug is injected accidentally without exposure to a nerve agent or if someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center. In people not exposed to nerve agents, symptoms of overdose may include: dizziness, vision problems, headache, nausea, fast heartbeat.
NOTES: After first-aid treatment and decontamination, more treatment in a hospital is usually needed. Consult your doctor for more details.
MISSED DOSE: Not applicable.
STORAGE: Store at room temperature away from light and moisture. Do not store in the bathroom. Keep all medications away from children and pets.From time to time, check the expiration date, and also check this product visually for particles or discoloration. Replace the unit before it expires or if particles/discoloration are present.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this medication when it is expired, used, or no longer needed. Consult your pharmacist or local waste disposal provider.
Information last revised February 2022. Copyright(c) 2022 First Databank, Inc.
IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.
Formulary
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