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Pralidoxime
💉 Pralidoxime is used as an adjunct to atropine in the treatment of poisoning by organophosphorus insecticides or nerve agents (e.g. sarin). It reactivates acetylcholinesterase, reversing the life-threatening cholinergic crisis.
📖 About
Always check the BNF link here for the latest prescribing information. Pralidoxime is an oxime antidote used in acute cholinesterase inhibitor poisoning.
⚙️ Mode of Action
- 🔓 Reactivates acetylcholinesterase by cleaving the phosphate-enzyme bond formed by organophosphates.
- ⚡ Restores normal breakdown of acetylcholine at neuromuscular junctions.
- 🛡️ Best given early (before “aging” of the phosphorylated enzyme, when reactivation becomes irreversible).
💊 Indications / Dose
- Organophosphate or nerve agent poisoning (e.g. sarin, parathion): 30 mg/kg IV infusion over 20 minutes, then 8 mg/kg/hour continuous infusion. ⚠️ Maximum 12 g in 24 hours.
- 👉 Always given in conjunction with atropine to control muscarinic effects (bronchorrhoea, bradycardia, bronchospasm).
🔗 Interactions
- 📖 See BNF for details.
- ⚠️ May interfere with anticholinesterases used in myasthenia gravis (e.g. neostigmine, pyridostigmine).
⚠️ Cautions
- 🤲 Myasthenia gravis – risk of precipitating weakness.
- 🧓 Use cautiously in elderly patients (risk of cardiac complications).
⛔ Contraindications
- 🚫 See BNF for full list.
- Relative: hypersensitivity to pralidoxime or oximes.
😬 Side Effects
- ⬆️ Hypertension, tachycardia or reflex bradycardia.
- 🤢 Nausea, vomiting, abdominal cramps.
- 🤕 Headache, dizziness, blurred vision, diplopia.
- 😮 Laryngospasm, muscle rigidity, hyperventilation (rare, high dose).
📚 References
- BNF: Pralidoxime
- WHO guidelines for organophosphate poisoning.
- UK Health Security Agency (UKHSA): Management of chemical incidents.
📝 Revisions
- Updated September 2025
| The content on this website is provided for educational and informational purposes only to support exam preparation (e.g., MLA, MRCP, USMLE) and learning. This is NOT medical advice, diagnosis, treatment, or professional guidance. It does not replace consultation with a qualified healthcare professional, official guidelines (e.g., NICE, GMC, BNF), or supervised clinical practice. Always verify information with current, authoritative sources. Makindo and its contributors accept no liability for any reliance on this content, including errors, omissions, or any resulting harm, loss, or consequences. By using this site, you agree to these terms. |
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