Page 163 - 2026 SMOG

PRALIDOXIME CHLORIDE (2-PAM CHLORIDE)
Class/Mechanism of Action
• Antidote for organophosphate anticholinesterase poisoning
Reactivates cholinesterase that had been inactivated by phosphorylation due to exposure
to organophosphate pesticides and cholinesterase-inhibiting nerve agents by displacing the
enzyme from its receptor sites; removes the phosphoryl group from the active site of the
inactivated enzyme.
˚ Peak plasma concentration—IV: 5–15min, IM: about 35min
Indications
• Labeled Indications
˚ Organophosphate Pesticide Poisoning: Used with Atropine to reverse muscle paralysis
˚ Chemical Warfare Agent Poisoning: Used with Atropine for treatment of nerve agent
(e.g., sarin, soman, tabun, VX [methylphosphonothioic acid])
Contraindications
• There are no absolute contraindications listed within the manufacturer’s labeling.
˚ Note: According to the manufacturer, relative contraindications include hypersensitivity
to pralidoxime or any component of the formulation and other situations where the risk of
administration clearly outweighs the possible benefit.
Adverse Reactions/Precautions
• Pralidoxime is not indicated for the treatment of poisoning due to phosphorus, inorganic
phosphates, or organophosphates without anticholinesterase activity.
˚ Renal impairment: Use with caution in patients with renal impairment; dosage modification
required
˚ Adverse Reactions can include cardiac arrest, hypertension, tachycardia, paralysis, seizure,
nausea, vomiting, apnea, hyperventilation, laryngospasm, and muscle rigidity. Provide
supportive care when appropriate/prn
˚ Pregnancy: Use if indicated as an antidote
˚ Lactation: Use caution
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2026 Standard Medical Operating Guidelines (SMOG) • 155