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DuoDote Dosage

Generic name: atropine 2.1mg in 0.7mL; pralidoxime chloride 600mg in 2mL
Dosage form: injection
Drug class: Antidotes

Medically reviewed by Last updated on Apr 4, 2022.

Important Administration Information

  • Three (3) single-dose DuoDote autoinjectors should be available for use in each patient (including healthcare providers) at risk for organophosphorus poisoning; one (1) for mild symptoms plus two (2) more for severe symptoms [see Dosage and Administration (2.2)]. Note that individuals may not have all symptoms included under the mild or severe symptom category.
  • Only administer DuoDote to patients experiencing symptoms of organophosphorus poisoning in a situation where exposure is known or suspected. The DuoDote autoinjector is intended as an initial treatment of the symptoms of organophosphorus nerve agent or insecticide poisonings as soon as symptoms appear; definitive medical care should be sought immediately.
  • The DuoDote autoinjector should be administered by healthcare providers who have had adequate training in the recognition and treatment of nerve agent or insecticide intoxication.
  • Close supervision of all treated patients is indicated for at least 48 to 72 hours.
  • Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration, whenever solution and container permit [see Dosage Forms and Strengths (3)].

Dosage Information

Dosage for Mild Symptoms in Adults and Pediatric Patients Weighing More Than 41 kg (90 Pounds)

First Dose: If the patient experiences two or more mild symptoms of nerve agent or insecticide exposure listed in Table 1, administer one (1) single-dose DuoDote injection intramuscularly into the mid-lateral thigh.

Additional Doses: If, at any time after the first dose, the patient develops any of the severe symptoms listed in Table 1, administer two (2) additional single-dose DuoDote injections intramuscularly in rapid succession.

Wait 10 to 15 minutes for DuoDote to take effect. If, after 10 to 15 minutes, the patient does not develop any of the severe symptoms listed in Table 1, no additional DuoDote injections are recommended.

Dosage for Severe Symptoms in Adults and Pediatric Patients Weighing More Than 41 kg (90 Pounds)

If a patient has any of the severe symptoms listed in Table 1, immediately administer three (3) single-dose DuoDote injections intramuscularly into the patient's mid-lateral thigh in rapid succession.

Table 1. Common Symptoms of Organophosphorus Exposure
Mild Symptoms Severe 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 of stomach cramps
  • Tachycardia or bradycardia
  • Strange or confused behavior
  • Severe difficulty breathing or copious secretions from lungs/airway
  • Severe muscular twitching and general weakness
  • Involuntary urination and defecation
  • Convulsions
  • Unconsciousness

Administration Instructions

*Do Not Remove Gray Safety Release until ready to use.

*Never touch the Green Tip (Needle End)!

Tear open the plastic pouch at any of the notches. Remove the DuoDote autoinjector from the pouch.
Place the DuoDote autoinjector in your dominant hand. (If you are right-handed, your right hand is dominant.) Firmly grasp the center of the DuoDote autoinjector with the Green Tip (needle end) pointing down.
With your other hand, pull off the Gray Safety Release. DuoDote is now ready to be administered.
The injection site is the mid-lateral thigh area. The DuoDote autoinjector can inject through clothing. However, make sure pockets at the injection site are empty. People who may not have a lot of fat at the injection site should also be injected in the mid-lateral thigh, but before giving the injection, bunch up the thigh to provide a thicker area for injection.
Firmly push the Green Tip straight down (a 90° angle) against the mid-lateral thigh. Continue to firmly push until you feel the DuoDote autoinjector trigger. After the autoinjector triggers, hold the DuoDote autoinjector firmly in place against the injection site for approximately 10 seconds.
Remove the DuoDote autoinjector from the thigh and look at Green Tip. If the needle is visible, the drug has been administered. If the needle is not visible, check to be sure the Gray Safety Release has been removed, and then repeat above steps beginning with Step 4, but push harder in Step 5.
After the drug has been administered, push the needle against a hard surface to bend the needle back against the DuoDote autoinjector.
Put the used DuoDote autoinjector back into the plastic pouch, if available. Leave used DuoDote autoinjector(s) with the patient to allow other medical personnel to see the number of DuoDote autoinjector(s) administered.
Immediately move yourself and the patient away from the contaminated area and seek definitive medical care for the patient.

Further information

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