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PRALIDOXIME CHLORIDE C Lactation?(Caution) Trade: 2-Pam Chloride
Class / Mechanism of Action
Antidote for organophosphate anticholinesterase poisoning
Peak plasma concentration following IM dose is reached in approximately 30min
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
• None in emergency setting
Adverse Reactions / Precautions
• Not effective in exposure to phosphorus, inorganic phosphates, or organophosphates that do not
possess anticholinesterase activity.
• Consider cautions and adverse reactions of Atropine when using together
• Monitor BP and cardiac rhythm
Dose and Administration:
Chemical Warfare Agent Poisoning:
Pesticide Poisoning:
Mild symptoms: Miosis or blurred vision, tearing, Pralidoxime (2-PAM) Drip Protocol 8-10mg/kg/hr
*given after 1800mg IM Injection (3 ATNAAs) if
runny nose, hypersalivation or drooling, wheezing, symptoms persist.
muscle fasciculations, nausea/vomiting.
Severe symptoms: behavioral changes, severe 1. Reconstitute 1g 2-PAM with 20mL of sterile
breathing difficulty, severe respiratory secretions, water
severe muscle twitching, involuntary defecation or
urination, seizures, unconsciousness. 2. Add 10mL 2Pam (500mg) to 100mL Bag of NS
and infuse over 5min
Chemical Warfare Agent Poisoning: 3. Prepare continuous infusion by mixing 1g (20mL
Mild to moderate symptoms: localized sweating, reconstituted) in 100mL bag of NS which will
muscle fasciculations, nausea, vomiting, weakness, provide a 10mg/mL solution. Can also prepare 10g
and/or dyspnea. in 1L NS for a 10mg/mL solution.
Severe symptoms: apnea, flaccid paralysis, 4. Begin continuous infusion at 10mg/kg/hr.
seizures, and/or unconsciousness.
DOSING: Chemical Warfare Agent Poisoning:
Auto-injector: IM into anterolateral aspect of thigh
and hold in place for 10 seconds. Organophosphate Anticholinesterase Nerve
• Pralidoxime chloride auto-injector single dose Agents:
600mg: (administer after Atropine). Repeat IM:
injections if symptoms remain after 15min. • Children 0–10 years of age and adolescents
Repeat again if not resolved after 2 nd 15min. >10 years of age who present with
• DuoDote®, ATNAA: For ≥2 mild symptoms, mild/moderate symptoms: 15mg/kg.
inject single dose. If severe symptoms develop, • Children 0–10 years of age and adolescents
inject 2 additional doses in rapid succession. >10 years of age who present with severe
• DuoDote®, ATNAA: For severe symptoms, symptoms: 25mg/kg.
utilize 3 auto-injectors (total dose: atropine • Children and Adolescents ≥40kg dose as adult
6.3mg and pralidoxime chloride 1800mg) in
rapid succession.
Note: DuoDote® and ATNAA auto-syringe provides
a sequential single IM dose of atropine (2.1mg) and
pralidoxime chloride (600mg) through one needle.

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