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Atropine / Pralidoxime Dosage

Medically reviewed on April 9, 2018.

Applies to the following strengths: 2.1 mg/0.7 mL-600 mg/2 mL

Usual Adult Dose for Organophosphate Poisoning

DuoDote(R) autoinjector:

Mild symptoms in patients over 41 kg, patient has 2 or more mild symptoms of poisoning:
First dose: 1 injection intramuscularly into the mid-lateral thigh
-If patient develops severe symptoms after first dose, give 2 additional injections intramuscularly in rapid succession
-Wait 10 to 15 minutes after first injection, if no severe symptoms develop, no additional injections are recommended.

Severe symptoms in patients over 41 kg:
Give 3 injections intramuscularly in rapid succession in the mid-lateral thigh


ATNAA(R):
-Self or buddy-administer by military personnel after donning protective mask and hood at the first sign of a chemical attack, and only if some or all mild symptoms are present.

Self aid: Administer 1 injection into the lateral thigh muscle or buttocks
-Wait 10 to 15 minutes for antidote to take effect; if you can ambulate and know who and where you are, you do not need a second injection
-If symptoms are not relieved by one injection, seek someone else to check your symptoms; a buddy must administer second and third injections if needed.

Buddy aid: For patients with severe symptoms:
-If one injection (self aid) has been administered, administer 2 more injections in rapid succession into the lateral thigh or buttocks.
-If no medication has been given, administer 3 injections in rapid succession into the lateral thigh or buttocks.


Mild symptoms:
-Blurred vision/miosis
-Excessive, unexplained teary eyes
-Excessive, unexplained runny nose
-Increased salivation such as sudden drooling
-Chest tightness or difficulty breathing
-Tremors throughout the body or muscular twitching
-Nausea and/or vomiting
-Unexplained wheezing, coughing, or increased airway secretions
-Acute onset stomach cramps
-Tachycardia or bradycardia
-Unexplained, sudden headache
-Localized sweating and muscular twitching in the area of contaminated skin

Severe symptoms:
-Strange or confused behavior
-Severe difficulty breathing or copious secretions form lungs/airway
-Severe muscular twitching and general weakness
-Involuntary urination and defection
-Convulsions
-Unconsciousness


Comments:
-Only administer for symptoms where organophosphorous poisoning is known or suspected.
-Administer as soon as possible after appearance of symptoms.

Use(s): Poisoning by organophosphorous nerve agents and organophosphorous insecticides.

Usual Adult Dose for Nerve Agent Poisoning

DuoDote(R) autoinjector:

Mild symptoms in patients over 41 kg, patient has 2 or more mild symptoms of poisoning:
First dose: 1 injection intramuscularly into the mid-lateral thigh
-If patient develops severe symptoms after first dose, give 2 additional injections intramuscularly in rapid succession
-Wait 10 to 15 minutes after first injection, if no severe symptoms develop, no additional injections are recommended.

Severe symptoms in patients over 41 kg:
Give 3 injections intramuscularly in rapid succession in the mid-lateral thigh


ATNAA(R):
-Self or buddy-administer by military personnel after donning protective mask and hood at the first sign of a chemical attack, and only if some or all mild symptoms are present.

Self aid: Administer 1 injection into the lateral thigh muscle or buttocks
-Wait 10 to 15 minutes for antidote to take effect; if you can ambulate and know who and where you are, you do not need a second injection
-If symptoms are not relieved by one injection, seek someone else to check your symptoms; a buddy must administer second and third injections if needed.

Buddy aid: For patients with severe symptoms:
-If one injection (self aid) has been administered, administer 2 more injections in rapid succession into the lateral thigh or buttocks.
-If no medication has been given, administer 3 injections in rapid succession into the lateral thigh or buttocks.


Mild symptoms:
-Blurred vision/miosis
-Excessive, unexplained teary eyes
-Excessive, unexplained runny nose
-Increased salivation such as sudden drooling
-Chest tightness or difficulty breathing
-Tremors throughout the body or muscular twitching
-Nausea and/or vomiting
-Unexplained wheezing, coughing, or increased airway secretions
-Acute onset stomach cramps
-Tachycardia or bradycardia
-Unexplained, sudden headache
-Localized sweating and muscular twitching in the area of contaminated skin

Severe symptoms:
-Strange or confused behavior
-Severe difficulty breathing or copious secretions form lungs/airway
-Severe muscular twitching and general weakness
-Involuntary urination and defection
-Convulsions
-Unconsciousness


Comments:
-Only administer for symptoms where organophosphorous poisoning is known or suspected.
-Administer as soon as possible after appearance of symptoms.

Use(s): Poisoning by organophosphorous nerve agents and organophosphorous insecticides.

Usual Pediatric Dose for Organophosphate Poisoning

DuoDote(R) autoinjector:

Mild symptoms in patients over 41 kg, patient has 2 or more mild symptoms of poisoning:
First dose: 1 injection intramuscularly into the mid-lateral thigh
-If patient develops severe symptoms after first dose, give 2 additional injections intramuscularly in rapid succession
-Wait 10 to 15 minutes after first injection, if no severe symptoms develop, no additional injections are recommended.

Severe symptoms in patients over 41 kg:
Give 3 injections intramuscularly in rapid succession in the mid-lateral thigh


Mild symptoms:
-Blurred vision/miosis
-Excessive, unexplained teary eyes
-Excessive, unexplained runny nose
-Increased salivation such as sudden drooling
-Chest tightness or difficulty breathing
-Tremors throughout the body or muscular twitching
-Nausea and/or vomiting
-Unexplained wheezing, coughing, or increased airway secretions
-Acute onset stomach cramps
-Tachycardia or bradycardia

Severe symptoms:
-Strange or confused behavior
-Severe difficulty breathing or copious secretions form lungs/airway
-Severe muscular twitching and general weakness
-Involuntary urination and defection
-Convulsions
-Unconsciousness

Comments:
-Only administer for symptoms where organophosphorous poisoning is known or suspected.

Use(s): Poisoning by organophosphorous nerve agents and organophosphorous insecticides.

Usual Pediatric Dose for Nerve Agent Poisoning

DuoDote(R) autoinjector:

Mild symptoms in patients over 41 kg, patient has 2 or more mild symptoms of poisoning:
First dose: 1 injection intramuscularly into the mid-lateral thigh
-If patient develops severe symptoms after first dose, give 2 additional injections intramuscularly in rapid succession
-Wait 10 to 15 minutes after first injection, if no severe symptoms develop, no additional injections are recommended.

Severe symptoms in patients over 41 kg:
Give 3 injections intramuscularly in rapid succession in the mid-lateral thigh


Mild symptoms:
-Blurred vision/miosis
-Excessive, unexplained teary eyes
-Excessive, unexplained runny nose
-Increased salivation such as sudden drooling
-Chest tightness or difficulty breathing
-Tremors throughout the body or muscular twitching
-Nausea and/or vomiting
-Unexplained wheezing, coughing, or increased airway secretions
-Acute onset stomach cramps
-Tachycardia or bradycardia

Severe symptoms:
-Strange or confused behavior
-Severe difficulty breathing or copious secretions form lungs/airway
-Severe muscular twitching and general weakness
-Involuntary urination and defection
-Convulsions
-Unconsciousness

Comments:
-Only administer for symptoms where organophosphorous poisoning is known or suspected.

Use(s): Poisoning by organophosphorous nerve agents and organophosphorous insecticides.

Renal Dose Adjustments

Data not available
-Patients with severe renal impairment may require less frequent doses after the initial dose.
-Pralidoxime can cause decreased renal function.

Liver Dose Adjustments

Data not available
-Patients with severe hepatic impairment may require less frequent doses after the initial dose

Precautions

CONTRAINDICATIONS:
-There are no absolute contraindications in the face of life-threatening poisoning by organophosphorous nerve agents

Safety and efficacy have not been established in patients weighing under 41 kg.

Consult WARNINGS section for additional precautions.

Dialysis

Data not available

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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