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Atropine / Pralidoxime Chloride
Pronunciation: AT-roe-peen/PRAL-i-DOX-eem KLOR-ide
- Injection, solution 2.1 mg per 0.7 mL atropine/600 mg per 2 mL pralidoxime
Atropine competitively blocks the effects of acetylcholine, including excess acetylcholine caused by organophosphorous poisoning, at muscarinic cholinergic receptors on smooth muscle, cardiac muscle, and secretory gland cells and in peripheral autonomic ganglia and the CNS.Pralidoxime
Pralidoxime reactivates acetylcholinesterase that has been inactivated by phosphorylation caused by an organophsphorous nerve agent or insecticide. Reactivated acetylcholinesterase hydrolyzes excess acetylcholine resulting from organophosphoruous poisoning to help restore impaired cholinergic neural function.
Special PopulationsRenal Function Impairment
Pralidoxime has not been evaluated in patients with renal function impairment; however, because pralidoxime is excreted primarily in the urine, consider dosage reduction in patients with renal function impairment.Hepatic Function Impairment
Pralidoxime has not been evaluated in patients with hepatic function impairment.
Indications and Usage
Treatment of poisoning by organophosphorous nerve agents as well as organophosphorous insecticides.
No absolute contraindications.
Dosage and AdministrationTreatment of Mild Symptoms
IM Administer 1 atropine/pralidoxime injection into the mid-lateral thigh if patient experiences 2 or more mild symptoms of nerve gas or insecticide exposure. After 10 to 15 minutes, if the patient does not develop any severe symptoms of organophosphorous poisoning, no additional injections are recommended, but seek definitive medical care (eg, hospitalization, respiratory support) immediately. For emergency personnel who have administered atropine/pralidoxime, an individual decision needs to be made to determine their capacity to continue to provide emergency care. If, at any time after the first dose, the patient develops any of the severe symptoms, administer 2 additional atropine/pralidoxime injections in rapid succession, and immediately seek definitive medical care.Treatment of Severe Symptoms
IM Administer 3 atropine/pralidoxime injections into the mid-lateral thigh in rapid succession and immediately seek definitive medical care. No more than 3 doses of atropine/pralidoxime should be administered unless definitive medical care is available.
- Emergency care should include removal of oral and bronchial secretions, maintenance of a patent airway, supplemental oxygen, and, if necessary, artificial respiration.
- An anticonvulsant (eg, diazepam) may be administered to treat convulsions if suspected in an unconscious patient.
- Nerve agents and some insecticides can mask motor signs of seizures.
- Close supervision of all severely poisoned patients is indicated for at least 48 to 72 h.
Store at 59° to 86°F. Keep from freezing. Protect from light.
Drug InteractionsAminophylline, morphine, phenothiazines, reserpine, succinylcholine, theophylline
Avoid use in treating organophosphorous poisoning.Barbiturates
Effects may be potentiated; use with caution.Mivacurium, succinylcholine
Reversal of neuromuscular effects of these agents may be accelerated.Pralidoxime
May potentiate the effect of atropine, causing signs of atropinization to occur earlier than when atropine is used alone.
Laboratory Test Interactions
None well documented.
Asystole, atrial fibrillation, atrial flutter, cardiac syncope, flushing, MI, palpitations, premature ventricular contractions, sinus tachycardia, tachycardia, ventricular fibrillation, ventricular flutter.Pralidoxime
Increased systolic and diastolic BP, tachycardia.
Confusion, dizziness, headache, loss of libido.Pralidoxime
Dizziness, drowsiness, headache, impaired accommodation, muscular weakness.
Maculopapular rash, petechial rash, scarletiniform rash.Pralidoxime
Decreased sweating, dry skin, rash.
Acute angle-closure glaucoma, blurred vision, dry eyes, photophobia.Pralidoxime
Blurred vision, diplopia.
Abdominal distention, abdominal pain, constipation, dry mouth, dysphagia, nausea and vomiting, paralytic ileas.Pralidoxime
Dry mouth, emesis, nausea.
Impotence, urinary hesitancy or retention.Pralidoxime
Decreased renal function.
Elevated ALT, AST, and creatine kinase.
Pain and tightness.
Anhydrosis with impaired temperature regulation; hypersensitivity reactions may include anaphylaxis, laryngospasm, and skin rash progressing to exfoliation.Pralidoxime
Category C .
Excreted in breast milk.Pralidoxime
Safety and efficacy not established.
Special Risk Patients
Under normal circumstances, atropine should be used with caution in elderly patients and patients with chronic pulmonary disease, disorders of heart rhythm (eg, atrial flutter), severe narrow-angle glaucoma, pyloric stenosis, prostatic hypertrophy, renal function impairment, or a recent MI.
A temporary increase in BP may occur, a known effect of pralidoxime.
Complete protection against exposure
Atropine and pralidoxime should not be relied upon to provide complete protection from chemical nerve agents and insecticide poisoning.
May occur with atropine, especially during vigorous physical activity when there is high ambient temperature.
Blurred vision, circulator collapse, death, dry skin and mucous membranes, fever, flushing, locomotor difficulties (including agitation, central depression, coma, confusion, delirium, disorientation, hallucinations), respiratory depression, tachycardia, widely dilated pupils that are poorly responsive to light.Pralidoxime
Blurred vision, diplopia, dizziness, headache, impaired accommodation, nausea, slight tachycardia, transient hypertension.
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