Pralidoxime Chloride (2-PAM)(pra li dox’ eem)
Protopam Chloride
PREGNANCY CATEGORY C
Drug Class
Antidote
Therapeutic Actions
Reactivates cholinesterase (mainly outside the CNS) inactivated by phosphorylation due to organophosphate pesticide or related compound. Relieves respiratory muscle paralysis related to organophosphate toxicity.
Indications
Antidote in poisoning due to organophosphate pesticides and chemicals with anticholinesterase activity
IM use as an adjunct to atropine in poisoning by nerve agents having anticholinesterase activity (autoinjector)
Control of overdose by anticholinesterase drugs used to treat myasthenia gravis
Contraindications and Cautions
Contraindicated with concomitant use of theophylline, morphine, aminophylline, and succinylcholine and allergy to any component of drug.
Use cautiously with impaired renal function, myasthenia gravis, pregnancy, lactation.
Available Forms
Injection—1 g
Dosages
Adults
Organophosphate poisoning: In absence of cyanosis, give atropine 2–4 mg IV. If cyanosis is present, give 2–4 mg atropine IM while improving ventilation; repeat
every 5–10 min until signs of atropine toxicity appear. Maintain atropinization for at least 48 hr. Give pralidoxime concomitantly: Inject an initial dose of 1–2 g pralidoxime IV, preferably as a 15- to 30-min infusion in 100 mL of saline. After 1 hr, give a second dose of 1–2 g IV if muscle weakness is not relieved. Give additional doses cautiously every 10–12 hr. If IV administration is not feasible or if pulmonary edema is present, give IM or subcutaneously.
Anticholinesterase (eg, neostigmine, pyridostigmine, ambenonium) overdose: 1–2 g IV followed by increments of 250 mg every 5 min.
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