Pralidoxime (2-PAM) : Therapeutic uses, Dosage & Side Effects

Pralidoxime : Therapeutic uses, Dosage & Side Effects

Pralidoxime 2-PAM(Oxime) is a Cholinesterase reactivator, used to treat Anti-cholinesterase poisoning FOR USE IN NERVE AGENT POISONING ONLY.
Dose : 1-2 gm (adult), 20-40 mg/kg (children)
Route : Intravenous
Plasma Half-life : ?
Duration of action : ?
Bioavailability : ?
Chemical formula : C7H9N2O+
IUPAC name : 2-[(hydroxyimino)methyl]-1-methylpyridin-1-ium
Trade name : Protopam, Neopam, Pam-A, Lyphe
Therapeutic uses : Pralidoxime used to treat Anti-cholinesterase poisoning.
Points of interest :

  • Pralidoximeis unable to penetrate into the CNS and therefore is not useful in treating the CNS effects of organophosphates.
  • it can reverse both muscarinic andnicotinic peripheral effects of organophosphates, but not the CNS
  • It cannot overcome toxicity of carbamate antiChEs (physostigmine,neostigmine, carbaryl, propoxur) in which case the anionic site of the enzyme is not free to provide attachment to pralidoxime.
  • It causes more marked reactivation of skeletalmuscle ChE than at autonomic sites and not at all in the CNS (does not penetrate).

Side effects :
Pralidoxime is a weak AChE inhibitor and, at higher doses, may cause side effects similar to other AChE inhibitors.

  • Blurred or double vision,
  • Change in near or distance vision,
  • Difficult or rapid breathing,
  • Difficulty in focusing the eyes,
  • Difficulty with speaking,
  • Dizziness,
  • Fast, pounding, or irregular heartbeat or pulse,
  • Muscle stiffness or weakness,
  • Pain at the injection site (after injection into a muscle).


  • The Pralidoxime Chloride auto-injector is contraindicated in patients who are hypersensitive to any component of the product.

For detailed query or in case of uncertainty, Always consult your doctor or pharmacist.

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