PRALIDOXIME (Systemic)
Some commonly used brand names are:
In the U.S.?
In Canada?
Generic name product may be available in the U.S.
Other commonly used names are 2-PAMand 2-PAM chloride.
Category
- Antidote, to cholinesterase inhibitors
- Antidote, to organophosphate chemicals
- Antidote, to organophosphate pesticides
Description
Pralidoxime (pra-li-DOX-eem) is used together with another medicine calledatropine to treat poisoning caused by organic phosphorus pesticides (e.g.,diazinon, malathion, mevinphos, parathion, and sarin) and by organophosphatechemicals (?nerve gases?) used in chemical warfare. Pralidoximeis also used to treat overdose of medicines, such as ambenonium, neostigmine,and pyridostigmine, that are used to treat myasthenia gravis. Poisoning withthese chemicals or medicines causes your muscles, including the muscles thathelp you breathe, to become weak. Pralidoxime is used to help you get backstrength in your muscles.
Pralidoxime is to be given only by or under the direct supervision of adoctor or trained military personnel. It is available in the following dosageform:
Parenteral- Injection (U.S. and Canada)
Before Using This Medicine
In deciding to use a medicine,the risks of taking the medicine must be weighed against the good it willdo. This is a decision you and your doctor will make. For pralidoxime, thefollowing should be considered:
Allergies?Tell your doctor if you have ever had any unusual orallergic reaction to pralidoxime. Also tell your health care professionalif you are allergic to any other substances, such as foods, preservatives,or dyes.
Pregnancy?Studies on effects in pregnancy have not been donein either humans or animals.
Breast-feeding?It is not known whether pralidoxime passes intobreast milk. Although most medicines pass into breast milk in small amounts,many of them may be used safely while breast-feeding. Mothers who are takingthis medicine and who wish to breast-feed should discuss this with their doctor.
Children?Although there is no specific information comparinguse of pralidoxime in children with use in other age groups, this medicineis not expected to cause different side effects or problems in children thanit does in adults.
Older adults?Many medicines have not been studied specificallyin older people. Therefore it may not be known whether they work exactly thesame way they do in younger adults or if they cause different side effectsor problems in older people. There is no information comparing use of pralidoximein the elderly with use in other age groups.
Other medicines?Although certain medicines should not be usedtogether at all, in other cases two different medicines may be used togethereven if an interaction might occur. In these cases, your doctor may want tochange the dose, or other precautions may be necessary. When you are usingpralidoxime, it is especially important that your health care professionalknow if you are taking any of the following:
- Aminophylline (e.g., Somophyllin) or
- Caffeine (e.g., NoDoz) or
- Theophylline (e.g., Theo-Dur, Somophyllin-T)?These medicinesmay make the effects of the poisoning worse
Other medical problems?The presence of other medicalproblems may affect the use of pralidoxime. Make sure you tell your doctorif you have any other medical problems, especially:
- Kidney disease?The effects of this medicine may be increased
- Myasthenia gravis?This medicine may make the condition worse
Proper Use of This Medicine
For patientsusing the pralidoxime auto-injector (automatic injection device):
- You will be trained to use the pralidoxime auto-injector by a medicor other trained military personnel. You will also be told the conditionsunder which it should be used. The auto-injector also comes with patient directions.Read them carefully before you actually need to use this medicine. Then, whenan emergency arises, you will know how to inject the pralidoxime.
- It is important that you do not remove the safety cap on the auto-injectoruntil you are ready to use it. This prevents spillage of the medicine fromthe device during storage and handling.
- To use the pralidoxime auto-injector:
- Remove the gray safety cap.
- Place the black tip of the device on the thigh, with the injectorpointed straight at the thigh.
- Press hard into the thigh until the auto-injector functions. Holdin place for several seconds. Remove the auto-injector and dispose of it asdirected.
- Massage the injected area for 10 seconds.
Use this medicine only as directed. Do not use moreof it and do not use it more often than your doctor or medic ordered.Do not use more than recommended on the label unless otherwise directed byyour doctor or medic.
Dosing?The dose of pralidoxime will be different fordifferent patients. Follow your doctor's or medic's ordersor the directions on the label. The following information includesonly the average doses of pralidoxime.
- For injection dosage form:
- For treatment of organic phosphorus pesticide poisoning:
- Adults and teenagers?The usual dose is 1 to 2 grams injectedinto a vein. The dose may be repeated after one hour, and then every eightto twelve hours if muscle weakness continues.
- Children?The dose is based on body weight and must be determinedby your doctor. It is usually 25 to 50 milligrams (mg) per kilogram (kg) (11.35to 22.7 mg per pound) of body weight injected into a vein. The dose may berepeated after one hour, and then every eight to twelve hours if muscle weaknesscontinues.
- For treatment of organic phosphorus chemical (?nerve gas?)poisoning:
- Adults?The usual dose is 600 mg injected into a muscle. Thedose may be repeated fifteen minutes after the first dose and again fifteenminutes after the second dose, if needed.
- Children?Dose must be determined by your doctor.
- For treatment of overdose of medicines used to treat myasthenia gravis:
- Adults and teenagers?At first, the dose is 1 to 2 grams injectedinto a vein. Then, the dose is 250 mg injected into a vein every five minutes.
- Children?Dose must be determined by your doctor.
Storage?To store this medicine:
- Keep out of the reach of children.
- Store away from heat and direct light.
- Keep the medicine from freezing. Do not refrigerate.
- Do not keep outdated medicine or medicine no longer needed. Be surethat any discarded medicine is out of the reach of children.
Precautions While Using This Medicine
Thismedicine will add to the effects of CNS depressants (medicines that may makeyou drowsy or less alert). Some examples of CNS depressants are antihistaminesor medicine for hay fever, other allergies, or colds; sedatives, tranquilizers,or sleeping medicine; prescription pain medicine or narcotics; barbiturates;medicine for seizures; muscle relaxants; or anesthetics, including some dentalanesthetics. Check with your doctor before taking any of the above while youare using this medicine.
Side Effects of This Medicine
Along with its needed effects, a medicine may cause some unwanted effects.Although not all of these side effects may occur, if they do occur they mayneed medical attention.
Check with your doctor as soon as possible if any of the following sideeffects occur:
Other side effects may occur that usually donot need medical attention. These side effects may go away during treatmentas your body adjusts to the medicine. However, check with your doctor if anyof the following side effects continue or are bothersome:
Other side effectsnot listed above may also occur in some patients. If you notice any othereffects, check with your doctor.
Additional Information
Once a medicine has been approvedfor marketing for a certain use, experience may show that it is also usefulfor other medical problems. Although this use is not included in product labeling,pralidoxime has been used in some patients to treat poisoning caused by certaincarbamate pesticides.
Other than the above information, there is no additional information relatingto proper use, precautions, or side effects for this use.
Revised: 04/01/1996
