Pralidoxime Brand Name– Protopam
What is Pralidoxime
Pralidoxime a quaternary ammonium oxime also known as 2-PAM, is an antidote used to reverse muscle paralysis resulting from organophosphate anticholinesterase poisoning.
Organophosphorus compounds are used as pesticides and developed as warfare nerve agents such as tabun, soman, sarin, VX, and others.
Respiratory failure is often considered to be the major fatal factor affecting organophosphate poisoning victims.
Respiratory failure in these patients typically consists of three components: increased airway resistance, weakness and paralysis of muscles of respiration, and depression of the central respiratory center.
Pralidoxime is a cholinesterase reactivator that exerts its effects primarily on skeletal neuromuscular junctions, which can relieve paralysis of skeletal muscle, including muscles of respiration.
Pralidoxime does not significantly relieve depression of the central respiratory center or decrease the muscarinic effects of anticholinesterase poisoning; therefore, atropine must be administered concomitantly to relieve muscarinic effects such as bronchoconstriction, bronchorrhea, bradycardia, and central nervous system effects.
Supportive measures, including maintenance of an adequate airway and ventilation and the prompt management of seizures, must be implemented simultaneously with pralidoxime administration.
Pralidoxime is also used to reverse the effects of overdosage of anticholinesterase agents used in the treatment of myasthenia gravis (i.e., neostigmine, pyridostigmine, and ambenonium).
Pralidoxime also has been used off-label prophylactically in workers before exposure to organophosphates, subconjunctively in the treatment of organophosphate anticholinesterase poisoning, and in the treatment of echothiophate ophthalmic solution overdose.
Pralidoxime was approved for use in adults by the FDA in 1964 and for use in pediatric patients in September 2010.
Indications
- cholinesterase inhibitor toxicity
- organophosphate insecticide toxicity
For use as an antidote to organophosphate insecticide toxicity
Side Effects
- agitation
- blurred vision
- diplopia
- dizziness
- drowsiness
- flushing
- headache
- hypertension
- hypertonia
- hyperventilation
- injection site reaction
- laryngospasm
- mania
- muscle paralysis
- myasthenia
- myoclonia
- nausea
- rash
- sinus tachycardia
- vomiting
- xerostomia
Monitoring Parameters
- laboratory monitoring not necessary
Contraindications
- breast-feeding
- geriatric
- myasthenia gravis
- pregnancy
- renal disease
- renal impairment
Interactions
- Acetaminophen; Butalbital
- Acetaminophen; Butalbital; Caffeine
- Acetaminophen; Butalbital; Caffeine; Codeine
- Ambenonium Chloride
- Amobarbital
- Amoxapine
- Anticholinergics
- Aspirin, ASA; Butalbital; Caffeine
- Aspirin, ASA; Butalbital; Caffeine; Codeine
- Atropine
- Atropine; Benzoic Acid; Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate
- Atropine; Difenoxin
- Atropine; Diphenoxylate
- Atropine; Edrophonium
- Atropine; Hyoscyamine; Phenobarbital; Scopolamine
- Barbiturates
- Belladonna Alkaloids; Ergotamine; Phenobarbital
- Belladonna; Opium
- Benzoic Acid; Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate
- Benztropine
- Bethanechol
- Butabarbital
- Cevimeline
- Chlordiazepoxide; Clidinium
- Cholinesterase inhibitors
- Dicyclomine
- Disopyramide
- Donepezil
- Donepezil; Memantine
- Edrophonium
- Flavoxate
- Galantamine
- Glycopyrrolate
- Glycopyrrolate; Formoterol
- Guanidine
- Homatropine; Hydrocodone
- Hyoscyamine
- Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate; Sodium Biphosphate
- Indacaterol; Glycopyrrolate
- Maprotiline
- Mepenzolate
- Mephobarbital
- Methenamine; Sodium Acid Phosphate; Methylene Blue; Hyoscyamine
- Methohexital
- Methscopolamine
- Neostigmine
- Oxybutynin
- Pentobarbital
- Phenobarbital
- Physostigmine
- Pilocarpine
- Primidone
- Propantheline
- Pyridostigmine
- Rivastigmine
- Scopolamine
- Secobarbital
- Tacrine
- Thiopental
- Tricyclic antidepressants
- Trihexyphenidyl
- Trospium
