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

 
Back to Medical Corps Pharmacy Page