pralidoxime (2-PAM)

Adult Dosing .

Dosage forms:  INJ

cholinesterase inhibitor overdose

[1-2 g IV x1, then 250 mg IV q5min until sx reverse]

organophosphate insecticide poisoning

[IV route]

Dose: 1-2 g IV x1; Max: 2 g/dose; Alt: 30 mg/kg/dose IV x1, then 8 mg/kg/h IV up to 500 mg/h; Info: give atropine first; may repeat 1-2 g IV in 1h, then q10-12h if muscle weakness persists; may repeat dose q3-8h if poisoning due to ingestion; decr. intermittent dose to 5-10 mg/kg IV if frail or elderly

[IM route, mild sx]

Dose: 0.6 g IM x1; Max: 0.6 g/dose, 3 doses/course; Info: give atropine first; repeat q15min x2 doses if mild sx persist; give 2 additional doses in rapid succession if severe sx develop; decr. dose to 10 mg/kg/dose IM if frail or elderly

[IM route, severe sx]

Dose: 0.6 g IM x3 doses in rapid succession; Max: 0.6 g/dose, 3 doses/course; Info: give atropine first; may repeat 3-dose regimen 1h after last dose if severe sx persist; decr. dose to 8 mg/kg/dose IM if frail or elderly

organophosphate nerve agent poisoning

[IV route]

Dose: 1-2 g IV x1; Max: 2 g/dose; Alt: 30 mg/kg/dose IV x1, then 8 mg/kg/h IV up to 500 mg/h; Info: give atropine first; may repeat 1-2 g IV in 1h, then q10-12h if muscle weakness persists; may repeat dose q3-8h if poisoning due to ingestion; decr. intermittent dose to 5-10 mg/kg IV if frail or elderly

[IM route, mild sx]

Dose: 0.6 g IM x1; Max: 0.6 g/dose, 3 doses/course; Info: give atropine first; repeat q15min x2 doses if mild sx persist; give 2 additional doses in rapid succession if severe sx develop; decr. dose to 10 mg/kg/dose IM if frail or elderly

[IM route, severe sx]

Dose: 0.6 g IM x3 doses in rapid succession; Max: 0.6 g/dose, 3 doses/course; Info: give atropine first; may repeat 3-dose regimen 1h after last dose if severe sx persist; decr. dose to 8 mg/kg/dose IM if frail or elderly

renal dosing

[adjust dose amount]

renal impairment: decr. usual dose, amount not defined

HD/PD: not defined

hepatic dosing

[not defined]

Peds Dosing .

Dosage forms:  INJ

organophosphate insecticide poisoning

[IV route, <16 yo]

Dose: 20-50 mg/kg/dose IV x1; Max: 2 g/dose; Alt: 20-50 mg/kg/dose IV x1, then 10-20 mg/kg/h IV; Info: give atropine first; may repeat 20-50 mg/kg/dose IV in 1h, then q10-12h if muscle weakness persists; may repeat dose q3-8h if poisoning due to ingestion

[IM route, mild sx, <40 kg]

Dose: 15 mg/kg/dose IM x1; Max: 0.6 g/dose, 3 doses/course; Info: give atropine first; repeat q15min x2 doses if mild sx persist; give 2 additional doses in rapid succession if severe sx develop

[IM route, mild sx, >40 kg]

Dose: 0.6 g IM x1; Max: 0.6 g/dose, 3 doses/course; Info: give atropine first; repeat q15min x2 doses if mild sx persist; give 2 additional doses in rapid succession if severe sx develop

[IM route, severe sx, <40 kg]

Dose: 15 mg/kg/dose IM x3 doses in rapid succession; Max: 0.6 g/dose, 3 doses/course; Info: give atropine first; may repeat 3-dose regimen 1h after last dose if severe sx persist

[IM route, severe sx, >40 kg]

Dose: 0.6 g IM x3 doses in rapid succession; Max: 0.6 g/dose, 3 doses/course; Info: give atropine first; may repeat 3-dose regimen 1h after last dose if severe sx persist

organophosphate nerve agent poisoning

[IV route, <16 yo]

Dose: 20-50 mg/kg/dose IV x1; Max: 2 g/dose; Alt: 20-50 mg/kg/dose IV x1, then 10-20 mg/kg/h IV; Info: give atropine first; may repeat 20-50 mg/kg/dose IV in 1h, then q10-12h if muscle weakness persists; may repeat dose q3-8h if poisoning due to ingestion

[IM route, mild sx, <40 kg]

Dose: 15 mg/kg/dose IM x1; Max: 0.6 g/dose, 3 doses/course; Info: give atropine first; repeat q15min x2 doses if mild sx persist; give 2 additional doses in rapid succession if severe sx develop

[IM route, mild sx, >40 kg]

Dose: 0.6 g IM x1; Max: 0.6 g/dose, 3 doses/course; Info: give atropine first; repeat q15min x2 doses if mild sx persist; give 2 additional doses in rapid succession if severe sx develop

[IM route, severe sx, <40 kg]

Dose: 15 mg/kg/dose IM x3 doses in rapid succession; Max: 0.6 g/dose, 3 doses/course; Info: give atropine first; may repeat 3-dose regimen 1h after last dose if severe sx persist

[IM route, severe sx, >40 kg]

Dose: 0.6 g IM x3 doses in rapid succession; Max: 0.6 g/dose, 3 doses/course; Info: give atropine first; may repeat 3-dose regimen 1h after last dose if severe sx persist

renal dosing

[adjust dose amount]

renal impairment: decr. usual dose, amount not defined

HD/PD: not defined

hepatic dosing

[not defined]