Pralidoxime Chloriode (2-PAM Chloride)

  1. Class
    Cholinesterase(used in the breakdown of acetylcholine) reactivator
  2. Mechanism of Action
    Reactivation of cholinesterase to effectively act as an antidote to organophosphate pesticide poisoning. This action allows for destruction of accumulated acetycholine at the nueromuscular junction.
  3. Indications
    As an antidote in the treatment of poisoning by organophosphate pesticides and chemicals. In the prehospital arena,is used when atropine is or has become ineffective in mamagement of organophosphate poisoning.
  4. Contraindications
    Use with caution in patients with reduced renal function; patients with myasthenia gravis(muscle weakness due to lack of acetylcholine) and organophosphate poisoning.
  5. Adverse Reactions
    Dizziness, blurred vision, diplopia(double vision), headache, drowsiness, nausea, tachycardia, hyperventialtion, muscular weakness, excitement, and manic behavior
  6. Drug Interactions
    No direct drug interactions; however, patients with organophosphate poisoning should not be given barbiturates, morphine, theophylline, aminophylline, succinylcholline, reserpine, and phenothiazines.
  7. How supplied
    Emergency single dose kit cintaining: One 20mL vial of 1g sterile protopam chloride. One 20mL ampule of sterile diluent. Sterile, disposable 20mL syringe. Needle and alcohol swab.
  8. Dosage and Administration
    • Note: If Protopam is to be used, it should be administered almost simultaneously with atropine.
    • Adult: Initial dose of 1-2g as an IV infusion with 100mL saline over 15-30 min.
    • Pediatric: 20-40 mg/kg as an IV infusion over 15-30 min. Doses may be repeated every 1 hour if muscle weakness persists. If IV administration is not feasible, IM or SC injection may be utilized.
  9. Duration of Action
    • Onset: minutes
    • Peak effects: variable
    • Duration: variable
  10. Special Considerations
    Pregnancey safety: Unknown. Treatment will be most effective if given within a few hours after poisoning. Cardiac monitoring should be considered in all cases of severe organophasphate poisoning.
Card Set
Pralidoxime Chloriode (2-PAM Chloride)
paramedic pharmacology