PROTOPAM Chloride (pralidoxime chloride) for Injection
Pralidoxime chloride is a cholinesterase reactivator.
PROTOPAM is indicated as an antidote: (1) in the treatment of poisoning due to those pesticides and chemicals of the organophosphate class which have anticholinesterase activity and (2) in the control of overdosage by anticholinesterase drugs used in the treatment of myasthenia gravis.
The principal indications for the use of pralidoxime are muscle weakness and respiratory depression. In severe poisoning, respiratory depression may be due to muscle weakness.
Published Studies Related to Protopam (Pralidoxime)
Pharmacokinetic analysis of pralidoxime after its intramuscular injection alone or in combination with atropine-avizafone in healthy volunteers. [2010.12]
BACKGROUND AND PURPOSE: Treatment of organophosphate poisoning with pralidoxime needs to be improved. Here we have studied the pharmacokinetics of pralidoxime after its intramuscular injection alone or in combination with avizafone and atropine using an auto-injector device... CONCLUSIONS AND IMPLICATIONS: The two approaches, non-compartmental and compartmental, showed that the administration of avizafone and atropine with pralidoxime results in a faster absorption into the general circulation and higher maximal concentrations, compared with the administration of pralidoxime alone.
Pralidoxime in acute organophosphorus insecticide poisoning--a randomised controlled trial. [2009.06.30]
CONCLUSIONS: Despite clear reactivation of red cell acetylcholinesterase in diethyl organophosphorus pesticide poisoned patients, we found no evidence that this regimen improves survival or reduces need for intubation in patients with organophosphorus insecticide poisoning. The reason for this failure to benefit patients was not apparent. Further studies of different dose regimens or different oximes are required.
Continuous pralidoxime infusion versus repeated bolus injection to treat organophosphorus pesticide poisoning: a randomised controlled trial. [2006.12.16]
BACKGROUND: The role of oximes for the treatment of organophosphorus pesticide poisoning has not been conclusively established. We aimed to assess the effectiveness of a constant pralidoxime infusion compared with repeated bolus doses to treat patients with moderately severe poisoning from organophosphorus pesticides... INTERPRETATION: A high-dose regimen of pralidoxime, consisting of a constant infusion of 1 g/h for 48 h after a 2 g loading dose, reduces morbidity and mortality in moderately severe cases of acute organophosphorus-pesticide poisoning.
Biochemical and clinical profile after organophosphorus poisoning--a placebo-controlled trial using pralidoxime. [2005.05]
BACKGROUND: Organophosphorus (OP) compounds are the most common suicidal poison in developing countries and mortality continues to be high... CONCLUSIONS: Treatment with P2AM does not make any difference in BuChE reactivation or complications of moderate and severe OP poisoning. We have not been using P2AM for OP poisoning in our medical ICU with good patient outcomes.
Efficacy of pralidoxime in organophosphorus poisoning: revisiting the controversy
in Indian setting. 
conducted in a tertiary care district hospital in West Bengal... CONCLUSION: The present study suggested that add-on pralidoxime with atropine
Clinical Trials Related to Protopam (Pralidoxime)
Is the WHO Recommended Dose of Pralidoxime Effective in the Treatment of Organophosphorus Poisoning? [Completed]
Adding Nebulized Salbutamol to Intravenous Atropine and Oxygen in OP Poisoning [Recruiting]
We hypothesize that salbutamol will speed removal of alveolar fluid compared to atropine
alone in OP poisoned patients. We propose to compare the effect of two stat doses of
nebulized salbutamol (2. 5 mg; 5. 0 mg), with nebulized saline placebo, in symptomatic
patients receiving standard resuscitation with atropine, oxygen, and fluids after poisoning
with OP pesticides. 25 patients will be randomised to each arm (total 75 patients). Primary
outcome will be oxygen saturation's over the following 60 min during resuscitation.
Secondary outcomes will include atropine dose administered, speed to stabilization,
aspiration or pneumonia, intubation, tachydysrhythmias, and mortality. A positive outcome
will result in design of a large definitive phase III study.