PRALIDOXIME CHLORIDE (pra-li-dox'eem) 2-PAM, Protopam Chloride Classifications: antidote; Therapeutic: antidote Pregnancy Category: C |
1 g injection
Reactivates cholinesterase inhibited by phosphate esters by displacing the enzyme from its receptor sites; the free enzyme then can resume its function of degrading accumulated acetylcholine, thereby restoring normal neuromuscular transmission.
More active against effects of anticholinesterases at skeletal neuromuscular junction than at autonomic effector sites or in CNS respiratory center; therefore, atropine must be given concomitantly to block effects of acetylcholine and its accumulation in these sites.
Antidote in treatment of poisoning by organophosphate insecticides and pesticides with anticholinesterase activity (e.g., parathion, TEPP, sarin) and to control overdosage by anticholinesterase drugs used in treatment of myasthenia gravis (cholinergic crisis).
To reverse toxicity of echothiophate ophthalmic solution.
Use in poisoning by carbamate; insecticide (Sevin), inorganic phosphates, or organophosphates having no anticholinesterase activity; asthma, peptic ulcer, severe cardiac disease, patients receiving aminophylline, theophylline, morphine, succinylcholine, reserpine, or phenothiazines; pregnancy (category C).
Myasthenia gravis; renal insufficiency; concomitant use of barbiturates in organophosphorus poisoning; lactation, children.
Organophosphate Poisoning Adult: IV 12 g in 100 mL NS infused over 1530 min; or 12 g as 5% solution in sterile water over not less than 5 min, may repeat after 1 h if muscle weakness not relieved. IM/SC 12 g if IV route is not feasible. Child: IV 2050 mg/kg. May repeat in 12 h if needed. Anticholinesterase Overdose in Myasthenia Gravis Adult: IV 12 g in 100 mL NS infused over 1530 min, followed by increments of 250 mg q5min prn |
Intravenous PREPARE: Direct: Reconstitute 1-g vial by adding 20 mL sterile water for injection to yield 50 mg/mL (a 5% solution). If pulmonary edema is present, give without further dilution. IV Infusion: Preferred method is to further dilute in 100 mL NS. ADMINISTER: Direct: In pulmonary edema, 1 g or fraction thereof over 5 min; do not exceed 200 mg/min. IV Infusion: Give over 1530 min (preferred).
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Assessment & Drug Effects