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Pralidoxime Injection (Pralidoxime Chloride Injection) - Drug Interactions, Contraindications, Overdosage, etc



Drug Interactions:

When atropine and pralidoxime are used together, the signs of atropinization (flushing, mydriasis, tachycardia, dryness of the mouth and nose) may occur earlier than might be expected when atropine is used alone. This is especially true if the total dose of atropine has been large and the administration of pralidoxime has been delayed.2, 3, 4

The following precautions should be kept in mind in the treatment of anticholesterinase poisoning, although they do not bear directly on the use of pralidoxime; since barbiturates are potentiated by the anticholinesterases, they should be used cautiously in the treatment of convulsions; morphine, theophylline, aminophylline, succinylcholine, reser-pine, and phenothiazine-type tranquilizers should be avoided in patients with organophosphate poisoning.


Manifestations of Overdosage:

Observed in normal subjects only: dizziness, blurred vision, diplopia, headache, impaired accommodation, nausea, slight tachycardia. In therapy it has been difficult to differentiate side effects due to the drug from those due to the effects of the poison.

Treatment of Overdosage:

Artificial respiration and other supportive therapy should be administered as needed.

Acute Toxicity:

  •  i.v.—man TDLo: 14 mg/kg (toxic effects: CNS)
  •  i.v.— rat LD50: 96 mg/kg
  •  i.m.—rat LD50: 150 mg/kg
  •  oral—mouse LD50: 4100 mg/kg
  •  i.p.—mouse LD50: 155 mg/kg
  •  i.v.—mouse LD50: 90 mg/kg
  •  i.m.—mouse LD50: 180 mg/kg
  •  i.v.—rabbit LD50: 95 mg/kg
  •  i.m.—guinea pig LD50: 168 mg/kg


The pralidoxime chloride auto-injector is contraindicated in patients who are hypersensitive to any component of the product.


Pralidoxime chloride is not subject to abuse and possesses no known potential for dependence.


  1. Landauer, W.: Cholinomimetic tetrogens. V. The effect of oximes and related cholinesterase reactivators, Teratology 15:33 (Feb.) 1977.
  2. Moller, K. O., Jenson-Holm, J., and Lausen, H. H.: Ugeskr. Laeg. 123:501, 1961.
  3. Namba, T., Nolte, C.T., Jackrel, Jr., and Grob, D.: Poisoning due to organophosphate insecticides. Acute and chronic manifestations, Amer. J. Med. 50:475 (Apr.) 1971.
  4. Arena, J. M.: Poisoning. Toxicology. Symptoms. Treatments, ed. 4, Springfield, Ill., Charles C.Thomas, 1979, p. 133.
  5. Brachfeld, J., and Zavon, M. R.: Organic phosphate (Phosdrin®) intoxication. Report of case and the results of treatment with 2-PAM, Arch. Environ. Health 11:859,1965.
  6. Hayes, W. J., Jr.: Toxicology of Pesticides, Baltimore, The Williams & Wilkins Company, 1975, p. 416.
  7. AMA Department of Drugs: AMA Drug Evaluations, ed. 4, Chicago, American Medical Association, 1980, p. 1455.

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