Anthropometric Measurements as Predictors of Low Birth Weight Among Tanzanian Neonates: A Hospital-Based Study
November 7, 2025
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Brand Name :
Protopam Chloride, 2PAM Antidote, pralidoxime Auto Injector
Synonyms :
2-PAM, Pralidoxim, Pralidoxima, pralidoxime, Pralidoximum
Class :
Cholinergic, Toxicity Antidotes
Brand Name :
Protopam Chloride, 2PAM Antidote, pralidoxime Auto Injector
Synonyms :
2-PAM, Pralidoxim, Pralidoxima, pralidoxime, Pralidoximum
Class :
Cholinergic, Toxicity Antidotes
Dosage Forms & StrengthsÂ
Injectable Solution (IM)Â
600 mg/2 mLÂ
Powder for reconstitution (IV)Â
1g/vialÂ
pralidoxime is given over 15 to 30 minutes via IV administration of 1 to 2 g (10-20 mg/mL), which should be repeated every 12 hours in a day when required. In case of pulmonary edema, administration of 50 mg/mL is given over 5 minutes. When muscle weakness is not relieved, wait for 1 hour and give 1 to 2 g as a second bolus, which may be repeated every 10 or 12 hours in a day when required
Alternatively, administration of 30 mg/kg IV infusion for over 20 minutes should be followed by 4 or 8 mg/kg/hour as a maintenance dose
At nicotinic sites, pralidoxime shows its maximum effect when used with atropine, which gives its effect on muscarinic receptors. This combination is known to increase the strength of muscle for 10 to 40 minutes
When administration is via IM, 600 mg infusion x 3 doses is recommended. Administration of each dose at 15-minute intervals for mild symptoms, or it is given in rapid succession in case of severe symptoms. The initial total dose should be at most 1800 mg. This series of 3 doses via IM is repeated with a time interval of 1 hour after the last IV if symptoms persist
Injectable Solution (IM)Â
600 mg/2 mLÂ
Powder for reconstitution (IV)Â
1g/vialÂ
IV administration
In children who are below the age of 16, pralidoxime 20 to 50 mg/kg/dose via IV administration not exceeding two g/dose, which should be followed by continuous IV infusion of 10 to 20 mg/kg/hour. IV bolus of 20 to 50 mg/kg/dose given over 1 hour as an alternative repeated after 10 or 12 hours where the condition of muscle weakness is not relieved
In children who are above the age of 16, pralidoxime 1 to 2 g via IV administration is infused over 15 to 30 minutes. If required, this is repeated after 1 hour. After that, this must be repeated after 12 hours a day when required. In case of pulmonary edema, an IV of 50 mg/mL is given over 5 minutes. A second bolus IV of 1 or 2 g is required after 1 hour when muscle weakness is not relieved, and this must be repeated after every 10 or 12 hours when required
IV of 30 mg/kg is administered alternatively over 20 minutes, which should be followed as an IV infusion maintenance dose of 4 to 8 mg/kg/hour
IM administration
When a child is below 40 kg weight, the dose administered via IM is 15 mg/kg/dose, which is multiplied three times with 15-minute intervals for mild symptoms that should not cross 45 mg/kg or via rapid succession in case of severe symptoms
When a child is above 40 kg weight, the dose is administered via IM 600 mg, which is multiplied three times with 15-minute intervals for mild symptoms that should not cross 45 mg/kg or via rapid succession in case of severe symptoms. The initial total dose should be at most 1800 mg
This series of 3 doses via IM is repeated with a time interval of 1 hour after the last IM if symptoms persist
Administration of IM should be in the anterolateral side of the thigh, where the nerve, vein, artery, and femur are avoided
Refer to the adult dosingÂ
may increase the neurotoxic effect
may increase the neurotoxic effect
may increase the neurotoxic effect
may increase the neurotoxic effect
may increase the neurotoxic effect
It may enhance the risk of adverse effects when combined with anticholinesterases
It may enhance the risk of adverse effects when combined with anticholinesterases
It may enhance the risk of adverse effects when combined with anticholinesterases
It may enhance the risk of adverse effects when combined with anticholinesterases
It may enhance the risk of adverse effects when combined with anticholinesterases
the excretion rate of abacavir, when decreased by pralidoxime, results in increased serum level
the excretion rate of tolbutamide, when decreased by pralidoxime, results in increased serum level
the excretion rate of tobramycin, when decreased by pralidoxime, results in increased serum level
the excretion rate of ampicillin, when decreased by pralidoxime, results in increased serum level
Actions and Spectrum:Â
Actions:Â
The antidote pralidoxime is used to reactivate cholinesterase, which is inactivated by phosphorylation that is observed in organophosphate poisoning and acetylcholinesterase inhibitor toxicity.Â
Spectrum:Â
The spectrum of pralidoxime is indicated for organophosphate poisoning and acetylcholinesterase inhibitor toxicity.
Frequency not defined Â
VomitingÂ
HypertensionÂ
DizzinessÂ
HeadacheÂ
ParalysisÂ
SeizureÂ
DrowsinessÂ
TachycardiaÂ
Cardiac arrestÂ
ApneaÂ
HyperventilationÂ
Blurred visionÂ
DiplopiaÂ
Abnormal accommodationÂ
Renal insufficiencyÂ
Increased AST and ALTÂ
Maculopapular rashÂ
WeaknessÂ
LaryngospasmÂ
FasciculationsÂ
Muscle rigidityÂ
Increased creatinine phosphokinaseÂ
Black Box Warning:Â
In case of emergency, when pralidoxime is given, the duty doctor needs to have the information that pralidoxime is given already.Â
Contraindication/Caution:Â
ContraindicationsÂ
CautionsÂ
Pregnancy consideration:Â Â
No data is available regarding the administration of the drug during pregnancy.Â
Breastfeeding warnings:Â Â
No data is available regarding the excretion of drug in breast milk.Â
Pregnancy category:Â
Category A: well-controlled and satisfactory studies show no risk to the fetus in the first or later trimester.Â
<b>Category B: there was no evidence of risk to the fetus in animal studies, and there were not enough studies on pregnant women.Â
Category C: there was evidence of risk of adverse effects in animal reproduction studies, and no adequate evidence in human studies must take care of potential risks in pregnant women.   Â
Category D: adequate data with sufficient evidence of human fetal risk from various platforms, but despite the potential risk, and used only in emergency cases for potential benefits.   Â
Category X: Drugs listed in this category outweigh the risks over benefits. Hence these categories of drugs need to be avoided by pregnant women.   Â
Category N: No data is available for the drug under this category.Â
Pharmacology:Â
The antidote pralidoxime is used to reactivate cholinesterase, which is inactivated by phosphorylation that is observed in organophosphate poisoning and acetylcholinesterase inhibitor toxicity.Â
Pharmacodynamics:Â
Reactivation of cholinesterase, which is inactivated by phosphorylation due to organophosphate poisoning. pralidoxime will then destroy the acetylcholine, which is accumulated, which will result in neuromuscular junctions to function normally.Â
Pharmacokinetics:Â
AbsorptionÂ
The time to achieve peak effect is 5 to 15 minutes for IV and 35 minutes via IM.Â
DistributionÂ
Protein-bound is NoneÂ
The volume of distribution of betrixaban is 0.6 to 2.7 L/kg. When a patient is poisoned seriously, then it is 9 L/kg, which can increase in pediatric populations.Â
MetabolismÂ
pralidoxime is metabolized in the liver.Â
Elimination and ExcretionÂ
The half-life is 1 – 1.5 hours. In poisoned adults, it is 3 to 4 hours, and in pediatrics, it is 2.4 to 5 hours.Â
The drug is excreted in urine as 80 % metabolites with unchanged drug.Â
Administration:Â
pralidoxime is injected into a vein or a muscle under the skin. IV preparation is reconstituted in the 1 g vial by adding 20 mL SWI to make a 50 mg/mL solution, which should be used within a few hours.Â
Further, if IV infusion is preferred, we need to dilute the amount of reconstituted solution, which is necessary to 100 mL NS given over 15 to 30 minutes, which can be given slowly as 5 min IVP.Â
If IM administration is chosen, then reconstitution of 1 g vial contents with 3 mL SWI or NS to make 300 mg/mL solution.Â
Patient information leafletÂ
Generic Name: pralidoximeÂ
Pronounced: prah-LEE-dox-eemÂ
Why do we use pralidoxime?Â
The antidote pralidoxime is used to reactivate cholinesterase, which is inactivated by phosphorylation that is observed in organophosphate poisoning and acetylcholinesterase inhibitor toxicity and to treat muscle disorder.Â
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