From the Guidelines
Yes, pralidoxime is used for organophosphate poisoning.
Key Points
- The use of pralidoxime is reasonable for organophosphate poisoning, as stated in the 2023 American Heart Association guidelines 1.
- The recommended dose of pralidoxime for organophosphate poisoning is 1-2 g for adults and 20-50 mg/kg for pediatrics, with a maintenance infusion of 400-600 mg/h for adults and 10-20 mg/kg/h for pediatrics 1.
- Pralidoxime is used in conjunction with other treatments, such as atropine, for the management of organophosphate poisoning.
- It is essential to consult a medical or clinical toxicologist, regional poison center, or topic-specific reference for detailed dosing and administration instructions, as the ideal dose of pralidoxime is not known and is often controversial 1.
From the FDA Drug Label
The principal action of pralidoxime chloride is to reactivate cholinesterase (mainly outside of the central nervous system) which has been inactivated by phosphorylation due to an organophosphate pesticide or related compound. Pralidoxime chloride also slows the process of “aging” of phosphorylated cholinesterase to a nonreactivatable form, and detoxifies certain organophosphates by direct chemical reaction. Regardless of whether or not animal studies suggest that the organophosphate poison to which a particular patient has been exposed is amenable to treatment with pralidoxime chloride, the use of pralidoxime chloride should, nevertheless, be considered in any life-threatening situation resulting from poisoning by these compounds
Yes, pralidoxime is used for organophosphate poisoning.
- The drug works by reactivating cholinesterase that has been inactivated by organophosphate pesticides or related compounds.
- It also slows the process of "aging" of phosphorylated cholinesterase and detoxifies certain organophosphates.
- Pralidoxime should be considered in any life-threatening situation resulting from organophosphate poisoning 2.
From the Research
Use of Pralidoxime in Organophosphate Poisoning
- Pralidoxime is used as an acetylcholinesterase (AChE) reactivator in the treatment of organophosphorus poisoning 3, 4, 5.
- The efficacy of pralidoxime in treating organophosphate poisoning has been debated, with some studies suggesting it may not be effective in improving outcomes 6, 7.
- A systematic review and meta-analysis of randomized trials found that pralidoxime did not significantly improve mortality or reduce the need for ventilator support, and may even increase the incidence of intermediate syndrome 7.
Administration and Dosage
- Pralidoxime can be administered through repeated pulse intramuscular injection or intravenous therapy 4.
- The dosage of pralidoxime varies, with some studies using an initial dose of 1 gm followed by a maintenance dose of 500mg 6 hourly 5.
- The World Health Organization (WHO) recommends specific doses of pralidoxime for the treatment of organophosphorus poisoning, which may not always be followed in clinical practice 5.
Clinical Evidence
- Clinical data indicate that changes in erythrocyte AChE activity correlate with neuromuscular function, suggesting that interactions between AChE, inhibitor, and oximes can be investigated in vitro with human erythrocyte AChE 3.
- A retrospective cohort study found that patients treated with pralidoxime had fewer atropine adverse effects and a shorter length of intensive care unit (ICU) stay compared to those who did not receive pralidoxime 4.
- However, other studies have found that pralidoxime may not affect the outcome of management in acute organophosphorus poisoning, and may even cause harm 6, 7.