Pralidoxime
Pralidoxime is an acetylcholinesterase reactivator used as an antidote for organophosphate and certain nerve agent poisoning. It works by binding to organophosphate compounds and restoring the function of acetylcholinesterase, which is critical for normal nerve signaling. This medication is typically used in emergency settings alongside atropine for comprehensive treatment of cholinergic toxicity.
Pralidoxime is an emergency antidote that reactivates acetylcholinesterase to reverse organophosphate poisoning, often used together with atropine.
Key facts at a glance
- ATC
- V03AB04
- RxNorm
- 34345
- Generic
- Pralidoxime
- Class
- atc-v03
- Brands
- Protopam, Duodote
- Availability
- rx
- Lactation
- unknown
- Routes
- —
- Forms
- solution, injection
- Regions
- US, EU, CN, JP
- Monitoring
- —
This page is for informational purposes only.
Do not use this information to diagnose yourself or to replace a physician's advice. Always consult a qualified healthcare provider before starting, stopping, or changing any medication. If you believe you are experiencing a medical emergency, call your local emergency number immediately.
Dosage and administration
- Usual dose
- 500mg twice daily
- Maximum
- consult physician
- Frequency
- every 12 hours
- Instructions
- Follow physician instructions
- Duration limits
- as prescribed
- Monitoring
- standard
- Usual dose
- 250mg twice daily
- Maximum
- consult physician
- Frequency
- every 12 hours
- Instructions
- Follow physician instructions
- Duration limits
- as prescribed
- Monitoring
- standard
- Usual dose
- 400mg daily
- Maximum
- consult physician
- Frequency
- once daily
- Instructions
- Follow physician instructions
- Duration limits
- as prescribed
- Monitoring
- standard
Overdose information
Special Populations
9 groupspregnancy
first trimesteruse lowest effective dose
use only if organophosphate poisoning is suspected and benefits outweigh potential risks
regular fetal monitoring
Use with caution and monitor for adverse effects.
pregnancy
second trimesteruse lowest effective dose
use only if organophosphate poisoning is suspected and benefits outweigh potential risks
regular fetal monitoring
Use with caution and monitor for adverse effects.
pregnancy
third trimesteruse lowest effective dose
use only if organophosphate poisoning is suspected and benefits outweigh potential risks
regular fetal and uterine monitoring
Use with caution and monitor for adverse effects.
lactation
not applicableno specific adjustment
discontinue breastfeeding or pump and discard milk during treatment
observe infant for signs of cholinergic effects
geriatric
elderlyreduce dose in renal impairment
assess renal function before dosing, use caution with comorbidities
monitor renal function and cholinesterase levels
Use with caution and monitor for adverse effects.
pediatric_age
pediatricweight-based dosing 20-40mg/kg
recommended for organophosphate poisoning in children, repeat dosing may be needed
monitor respiratory status, cholinesterase levels, and cardiac function
renal_impairment
mildno adjustment needed
standard dosing may be used, monitor response
monitor renal function during treatment
Use with caution and monitor for adverse effects.
renal_impairment
severereduce dose or extend interval
reduce dose by 25-50% in severe renal impairment, consider extended dosing interval
frequent monitoring of renal function and clinical response
Use with caution and monitor for adverse effects.
hepatic_impairment
mild moderateno adjustment needed
standard dosing recommended, drug minimally metabolized by liver
monitor clinical response
Statistics and clinical data
FDA approval year
FDA approval for organophosphate poisoning treatment
Drug class
Oxime class acetylcholinesterase reactivator
Primary indication
Treatment of organophosphate and nerve agent toxicity
Commonly used with
Standard combination therapy for organophosphate toxicity
Treatment of organophosphate and carbamate pesticide poisoning, as well as nerve agent exposure. Used in hospital emergency departments and toxicology units for acute cholinergic crisis.
Pralidoxime binds to organophosphate compounds that have attached to acetylcholinesterase enzymes, displacing them and restoring the enzyme's ability to break down acetylcholine. This reverses the excessive cholinergic stimulation caused by organophosphate exposure.
Most effective when given early, ideally before organophosphate-enzyme complex 'ages.' Often administered after atropine, which controls muscarinic symptoms. Requires intravenous or intramuscular administration. Must be used under medical supervision in emergency care settings. Effectiveness decreases if given after organophosphate has fully bound to the enzyme.
Contraindications
Conditions and patient states where this medication should be avoided or used with caution.
Do not use (1)
Known allergy to this medication or its components
Use caution (1)
Consult healthcare provider for benefits vs risks assessment
Official drug label
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This information is for educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment.
This content is for general informational and educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the guidance of a qualified healthcare provider with any questions you have about a medical condition, and never disregard professional medical advice or delay seeking it because of something you read here.
If you think you may have a medical emergency, call your local emergency number or go to the nearest emergency department immediately.
Medically reviewed by WellAlly Editorial Team Last reviewed July 26, 2026. · Read our editorial policy