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Pralidoxime chloride

Aka: Pralidoxime chloride, Protopam chloride, 2-PAMCl

Indications
1. Nerve Agent Exposure
2. Organophosphate Exposure
3. Not indicated for pure Carbamate Poisoning
Pharmacokinetics
1. Binds nerve agent and breaks agent-enzyme bond
2. Less effective after nerve agent aging occurs
  1. Soman (GD) ages in 2 minutes
  2. Other nerve agents age over 24-48 hours
Dosing: Emergency Department
1. Initial IV bolus
  1. Adult: 1-2 grams IV over 10 minutes
  2. Child age < 12 years: 20-50 mg/kg IV over 30 minutes
2. Maintenance Protocol 1 (bolus)
  1. Repeat dosing above in 1-2 hours
  2. May re-administer q10-12 hours prn symptoms
3. Maintenance Protocol 2 (Continuous infusion)
  1. Continuous IV 10-20 mg/kg/hr up to 500 mg per hour
  2. Discontinue at 24 hours
Dosing: Military (MARK I Kit)
1. MARK I Kit Autoinjector contains 2-PAMCl 600 mg
2. Atropine usually administered prior to 2-PAMCl
Precautions
1. Do NOT administer more than 3
2. Cardiac Arrest risk

Family Practice Notebook

Patients should address specific medical concerns with their physicians.

Although access to this page is not restricted, the information found here is intended for use by medical providers.

This page was written by Scott Moses, MD, last revised on 10/21/2007 and last published on 5/17/2012.

This is one of 5740 pages in the Family Practice Notebook