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Pralidoxime: Wikis


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Systematic (IUPAC) name
CAS number 6735-59-7
ATC code V03AB04
PubChem 5353894
DrugBank APRD01193
Chemical data
Formula C 7H9N2O+
Mol. mass 137.159 g/mol
Synonyms 1-methylpyridine-6-carbaldehyde oxime
Pharmacokinetic data
Bioavailability  ?
Metabolism  ?
Half life  ?
Excretion  ?
Therapeutic considerations
Pregnancy cat.  ?
Legal status
Routes  ?
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Pralidoxime belongs to a family of compounds called oximes that bind to organophosphate-inactivated acetylcholinesterase. It is used to combat poisoning by organophosphates or acetylcholinesterase inhibitors (nerve agents), in conjunction with atropine and diazepam. Pralidoxime is most commonly in the form of Pralidoxime Chloride, also known as 2-PAM Cl (or just 2-PAM by the military). As the iodide salt (methiodide), it is also called pyridine aldoximine methiodide or pyridine aldoxime methiodide (PAM).


Mechanism of action

Pralidoxime reversibly binds to the enzyme acetylcholinesterase, competing with organophosphate binding. However, 2-PAM does not inactivate the enzyme and is therefore thought to dislodge or block organophosphates from inactivating acetylcholinesterase. However, organophosphates ultimately irreversibly bind to acetylcholinesterase, requiring early administration of 2-PAM. Note that meta-analyses of the use of "-oximes" (like 2-PAM) in organophosphate poisoning have not demonstrated any benefit (and their use may be harmful). There are no controlled studies.


Recommended dosages, according to online sources, seem to be:

  • Adults: 30 mg/kg (Typically 600 mg - 2 g), administered either by intravenous therapy or intramuscular injection, possibly repeated 15 to 60 minutes later till the maximum dose is reached
  • Children: 50 mg/kg


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.

The following precautions should be kept in mind in the treatment of anticholinesterase 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, reserpine, and phenothiazine-type tranquilizers should be avoided in patients with organophosphate poisoning.


There are no known absolute contraindications for the use of pralidoxime. Relative contraindications include known hypersensitivity to the drug and other situations in which the risk of its use clearly outweighs possible benefit.

See also

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