NERVE AGENT PRE-TREATMENT TABLET SET L1A1 (NAPS L1A1)
Active substance(s): PYRIDOSTIGMINE BROMIDE
3mm print-free area
PACKAGE LEAFLET: INFORMATION FOR THE USER
NERVE AGENT PRE-TREATMENT SET L1A1 (NAPS L1A1)
Pyridostigmine Bromide Tablets
Read all of this leaflet carefully before you start taking this medicine.
Keep this leaflet. You may need to read it again.
If you have any questions or are in doubt about anything or
require further information, please ask your doctor or medical
If any of the side effects get serious, or if you notice any sideeffects not listed in this leaflet, please tell your doctor or medical
In this leaflet:
1. What NAPS is and what it is used for
2. Before you take NAPS
3. How to take NAPS
4. Possible side-effects
5. How to store NAPS
6. Further information
1. WHAT NAPS IS AND WHAT IT IS USED FOR
NAPS tablets contain pyridostigmine bromide which belongs
to a group of medicines known as cholinesterase inhibitors.
This medicine reduces the action of proteins in the body called
cholinesterases. This helps to counteract the effects of some
nerve agents and NAPS is taken as a pre-treatment before a
nerve agent attack occurs.
2. BEFORE YOU TAKE NAPS
Do not take NAPS if you:
• are allergic to pyridostigmine, bromides or any of the
other ingredients of NAPS. The other ingredients are listed
in Section 6 of this leaflet. If you think you are allergic, ask
your doctor or medical officer for advice.
• are constipated or cannot urinate (gastro-intestinal or
urinary obstruction), contact your doctor or medical officer
for advice before taking NAPS
• have been told by your doctor that you have a hereditary
intolerance to some sugars, contact your doctor or
medical officer before taking NAPS.
NAPS tablets should not be given to children or older people.
Take special care with NAPS if you have:
• asthma - if you have unstable asthma you should have been
medically downgraded in order that you are only deployed
within base areas where full medical support is available
• recently had a coronary thrombosis (heart attack)
• a slow heart beat
• vagotonia (a condition where over-activity of the vagus
nerve causes symptoms such as constipation, slow heart
rate, low blood pressure, sweating and painful muscle
• low blood pressure
Taking other medicines:
Please tell your doctor or medical officer if you are taking or
have recently taken any other medicines, including medicines
obtained without a prescription.
The following medicines can prevent your NAPS tablets from
• Antispasmodic medicines e.g. atropine, hyoscine (for
motion sickness, gastrointestinal spasm)
• Some antibiotics (aminoglycosides, clindamycin,
• Propranolol (for hypertension, angina or migraine
• Lithium (for manic depression, bipolar disorder)
• Procainamide, propafenone or quinidine (for irregular
If you are going to have an operation which requires a general
anaesthetic, you must tell the medical staff that you have been
Pregnancy and breast-feeding:
The effects of NAPS in pregnant women are not known, therefore
the use of NAPS is not recommended. You are advised not
to become pregnant while taking NAPS. If you do become
pregnant, you should consult your doctor or medical officer.
It is not known if NAPS passes into breast milk so you should
not breast feed if you are taking NAPS.
Driving and using machines:
The recommended dose of NAPS tablets does not affect your
ability to drive or use machines.
Important information about some of the ingredients of
Lactose is an ingredient in NAPS (see Section 6). If you have
an intolerance to some sugars, please tell your doctor before
3. HOW TO TAKE NAPS
5. HOW TO STORE NAPS
You should only begin taking NAPS when ordered to do so in
anticipation of a nerve agent attack.
Keep out of the reach and sight of children
Take one tablet by mouth every 8 hours until the order is given
to stop taking the medicine. The length of time for which NAPS
is taken will be determined by commanders on medical and
Do not take more than 2 tablets in an 8 hour period.
NAPS is not recommended for use in children or the elderly.
If you take more NAPS than you should
You may notice that you have stomach or muscle cramps,
diarrhoea, nausea and vomiting, increased salivation, sweating,
general weakness, a slower heart rate, twitching or lightheadedness.
If you experience any of these symptoms you must seek medical
assistance so that you can be treated.
If you forget to take NAPS
If you miss a tablet, you should take the next dose as soon
as possible, but do not take more than 2 tablets in an 8 hour
4. POSSIBLE SIDE-EFFECTS
Like all medicines, NAPS can cause side-effects, although not
everybody gets them.
Common – affecting fewer than 1 in 10 people
• stomach cramps
• more saliva than usual
• urinating more than usual, or feeling an urgent need to
• runny nose.
Uncommon – affecting fewer than 1 in 100 people
• worsening of asthma.
If any of these side-effects get serious, or if you notice
any side-effects not listed in this leaflet, please tell
your doctor or medical officer.
Do not use NAPS tablets after the expiry date which is printed
on the packaging after “exp”. The expiry date refers to the last
day of the month.
Do not store above 25°C
Keep the plastic sleeve in the outer foil in order to protect from
Return any unused tablets to your Quartermaster’s Dept. for
6. FURTHER INFORMATION
What NAPS contains
The active substance is pyridostigmine bromide 31.5mg
The other ingredients are starch pregelatinised, maize
starch, lactose monohydrate, silica colloidal, anhydrous talc,
(see also Section 2: Important information about some of the
ingredients of NAPS).
What NAPS looks like and contents of the pack
The NAPS tablets are round, biconvex, white to off-white colour,
marked with “L1A1” on one side.
They are packed in a blister pack in a plastic sleeve. Each sleeve
contains 21 tablets and is sealed in an aluminium foil sachet.
Ten foil sachets are packaged in one cardboard box.
Marketing Authorisation Holder
Secretary of State for Defence
Ministry of Defence
London SW1 2HB
Penn Pharmaceutical Services Limited
Units 23 & 24
Tafarnaubach Industrial Estate
Source: Medicines and Healthcare Products Regulatory Agency
Disclaimer: Every effort has been made to ensure that the information provided here is accurate, up-to-date and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. This information has been compiled for use by healthcare practitioners and consumers in the United States. The absence of a warning for a given drug or combination thereof in no way should be construed to indicate that the drug or combination is safe, effective or appropriate for any given patient. If you have questions about the substances you are taking, check with your doctor, nurse or pharmacist.