PRALIDOXIME, 2%, vial powder + 10ml amp. diluent

• Not in the WHO list of Essential Medicines 2023

Cholinesterase reactivator

Antidote to organophosphates which bind to the esteratic site of acetylcholinesterase, which results initially in reversible inactivation of the enzyme.

Poisoning caused by organic phosphorous pesticides (diazinon, malathion, parathion, sarin...) and by organophosphate chemicals ("nerve gases") used in chemical warfare.

To be administered in combination with atropine injectable.

Reconstitute the powder vial with the solvent provided.

Administer the reconstituted solution either as:

• slow IV injection
• IV infusion in 5% dextrose or 0.9% NaCl
• IM injection

Dosage :

Adults :

• initial dose: 2 g as slow IV or IM injection in severe forms (respiratory or neurological distress). Start with 200 to 400 mg in other cases and increase if necessary.
• maintenance dose: IV infusion of 5-8 mg/kg/h, or repeated injections of 200-400 mg depending on the clinical progress (e.g. every 4 hrs).

Children:

• initial dose: 40 mg/kg as slow IV (over 15 min) or IM injection in severe forms (respiratory or neurological distress). Start with 20 mg/kg in other cases and increase if necessary.
• maintenance dose: 10 mg/kg/hour as long as necessary

Administer immediately after poisoning. Pralidoxime has little effect if the delay between intoxication and the start of treatment is greater than 36 hrs.

Administration of pralidoxime must be accompanied by management of vital needs (airway management, respiratory and cardiovascular support), atropinisation and decontamination.