Pralidot

• Treatment of organophosphate poisoning, including insecticides and nerve agents, to reverse cholinergic toxicity.
• Adjunctive therapy with atropine for management of acute organophosphate poisoning symptoms.
• Management of carbamate poisoning in selected cases.
• Emergency treatment in suspected exposure to chemical warfare nerve agents.

• Adults:
  Initial dose of 1–2 grams administered intravenously over 15 to 30 minutes. May repeat doses of 0.5–1 gram every 1 to 2 hours as needed based on clinical response, or continuous infusion of 500 mg/hour for 24 to 48 hours.
• Pediatrics:
  20–50 mg/kg intravenously over 15 to 30 minutes. Repeat dosing as necessary.
• Elderly:
  Use standard dosing with careful monitoring for adverse effects.
• Route:
  Intravenous (preferred), intramuscular if IV access is not available.
• Duration:
  Continue treatment until resolution of symptoms and restoration of acetylcholinesterase activity.
• Dose adjustments:
  No specific adjustments for renal or hepatic impairment; monitor clinical status.

Pralidoxime chloride reactivates acetylcholinesterase inhibited by organophosphate compounds by cleaving the bond between the enzyme and the organophosphate. This restores the enzyme’s function, allowing breakdown of excess acetylcholine at neuromuscular junctions. The result is reversal of both muscarinic and nicotinic symptoms, including muscle weakness, respiratory paralysis, and excessive secretions.

• Absorption: Rapid absorption following IV or IM administration.
• Distribution: Distributed in extracellular fluids; limited penetration across the blood-brain barrier.
• Metabolism: Minimal metabolism.
• Elimination: Primarily renal excretion unchanged.
• Onset: Effects begin within minutes of IV administration.
• Half-life: Approximately 1 to 2 hours.

• Pregnancy: Category C. No adequate human studies; use only if potential benefit justifies risk.
• Lactation: Unknown if excreted in breast milk; use caution.

• Cholinesterase reactivator
• Antidote for organophosphate poisoning

• Hypersensitivity to pralidoxime chloride or any components
• Use with caution in myasthenia gravis patients
• Severe renal impairment (use cautiously)

• Risk of muscle weakness or respiratory distress if administered too rapidly.
• Monitor cardiovascular status; may cause hypertension and tachycardia.
• Early administration is critical; ineffective once acetylcholinesterase “aging” occurs.
• Monitor renal function during therapy.

• Common: Dizziness, headache, blurred vision, nausea, flushing, tachycardia.
• Rare but serious: Hypertension, laryngospasm, muscle rigidity, respiratory failure.

• Synergistic effects with atropine.
• Potential additive muscle weakness with neuromuscular blocking agents.
• No known CYP450 interactions.

• Reinforced early use in organophosphate poisoning for improved outcomes.
• Updated dosing regimens suggest continuous infusion in severe cases.

• Store at 20°C to 25°C (68°F to 77°F).
• Protect from light and moisture.
• Keep vial tightly closed.
• Do not freeze.