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Pralidoxime Dosage

Medically reviewed by Drugs.com. Last updated on Jun 18, 2024.

Applies to the following strengths: 1 g

Usual Adult Dose for Organophosphate Poisoning

Intravenous dosing (preferred route of administration):
Initial dose: 1 to 2 g, preferably as an IV infusion in 100 mL of normal saline, over 15 to 30 minutes; if an infusion is not practical or if pulmonary edema is present, the dose should be given slowly (over at least 5 minutes) by IV injection as a 50 mg/mL solution in Sterile Water for Injection (e.g., 1000 mg in 20 mL)

Second dose: 1 to 2 g may be indicated after about 1 hour if muscle weakness has not been relieved

Additional doses may be given every 10 to 12 hours if muscle weakness persists.

Intramuscular dosing (based on severity of symptoms):
MILD SYMPTOMS:
Initial dose: 600 mg IM; recommend waiting 15 minutes for pralidoxime to take effect
Second dose: 600 mg IM if mild symptoms persist after 15 minutes
Third dose: 600 mg IM (cumulative dose of 1800 mg) if mild symptoms persist after an additional 15 minutes

If severe symptoms develop at any time after the first dose, 2 additional 600 mg IM doses in rapid succession should be administered for a total cumulative dose of 1800 mg.

SEVERE SYMPTOMS: Three 600 mg IM doses in rapid succession should be administered for a total cumulative dose of 1800 mg.

PERSISTENT SYMPTOMS: If symptoms persist after administration of the complete 1800 mg regimen, the series may be repeated starting about 1 hour after the administration of the last injection.

Comments:


Use(s): Antidote for poisoning due to pesticides and chemicals (e.g. nerve agents) of the organophosphate class that have anticholinesterase activity

Usual Adult Dose for Nerve Agent Poisoning

Intravenous dosing (preferred route of administration):
Initial dose: 1 to 2 g, preferably as an IV infusion in 100 mL of normal saline, over 15 to 30 minutes; if an infusion is not practical or if pulmonary edema is present, the dose should be given slowly (over at least 5 minutes) by IV injection as a 50 mg/mL solution in Sterile Water for Injection (e.g., 1000 mg in 20 mL)

Second dose: 1 to 2 g may be indicated after about 1 hour if muscle weakness has not been relieved

Additional doses may be given every 10 to 12 hours if muscle weakness persists.

Intramuscular dosing (based on severity of symptoms):
MILD SYMPTOMS:
Initial dose: 600 mg IM; recommend waiting 15 minutes for pralidoxime to take effect
Second dose: 600 mg IM if mild symptoms persist after 15 minutes
Third dose: 600 mg IM (cumulative dose of 1800 mg) if mild symptoms persist after an additional 15 minutes

If severe symptoms develop at any time after the first dose, 2 additional 600 mg IM doses in rapid succession should be administered for a total cumulative dose of 1800 mg.

SEVERE SYMPTOMS: Three 600 mg IM doses in rapid succession should be administered for a total cumulative dose of 1800 mg.

PERSISTENT SYMPTOMS: If symptoms persist after administration of the complete 1800 mg regimen, the series may be repeated starting about 1 hour after the administration of the last injection.

Comments:


Use(s): Antidote for poisoning due to pesticides and chemicals (e.g. nerve agents) of the organophosphate class that have anticholinesterase activity

Usual Adult Dose for Anticholinesterase Overdose

Initial dose: 1 to 2 g IV slowly
Maintenance dose: Increments of 250 mg IV every 5 minutes as needed to control symptoms


Comments:

Use(s): Control of overdosage by anticholinesterase drugs such as neostigmine, pyridostigmine, and ambenonium, used in the treatment of myasthenia gravis

Usual Pediatric Dose for Organophosphate Poisoning

16 years and younger:

Intravenous administration (preferred method of administration):
LOADING DOSE FOLLOWED BY CONTINUOUS INFUSION
Loading dose: 20 to 50 mg/kg (maximum 2000 mg/dose) of a 10 to 20 mg/mL solution, intravenously over 15 to 30 minutes

INTERMITTENT INFUSION
Initial dose: 20 to 50 mg/kg (maximum 2000 mg/dose) of a 10 to 20 mg/mL solution, intravenously over 15 to 30 minutes


Intramuscular dosing (based on severity of symptoms):
Weight under 40 kg: 15 mg/kg per single dose; 45 mg/kg total (3 injection) dose
Weight 40 kg and above: 600 mg per single dose; 1800 mg total (3 injection) dose

MILD SYMPTOMS: Give weight appropriate dose (see above) intramuscularly; allow 15 minutes for drug to take effect

SEVERE SYMPTOMS: Administer three weight appropriate doses intramuscularly in rapid succession.

PERSISTENT SYMPTOMS:


Comments:

Use(s): Antidote for poisoning due to pesticides and chemicals (e.g. nerve agents) of the organophosphate class that have anticholinesterase activity

Usual Pediatric Dose for Nerve Agent Poisoning

16 years and younger:

Intravenous administration (preferred method of administration):
LOADING DOSE FOLLOWED BY CONTINUOUS INFUSION
Loading dose: 20 to 50 mg/kg (maximum 2000 mg/dose) of a 10 to 20 mg/mL solution, intravenously over 15 to 30 minutes

INTERMITTENT INFUSION
Initial dose: 20 to 50 mg/kg (maximum 2000 mg/dose) of a 10 to 20 mg/mL solution, intravenously over 15 to 30 minutes


Intramuscular dosing (based on severity of symptoms):
Weight under 40 kg: 15 mg/kg per single dose; 45 mg/kg total (3 injection) dose
Weight 40 kg and above: 600 mg per single dose; 1800 mg total (3 injection) dose

MILD SYMPTOMS: Give weight appropriate dose (see above) intramuscularly; allow 15 minutes for drug to take effect

SEVERE SYMPTOMS: Administer three weight appropriate doses intramuscularly in rapid succession.

PERSISTENT SYMPTOMS:


Comments:

Use(s): Antidote for poisoning due to pesticides and chemicals (e.g. nerve agents) of the organophosphate class that have anticholinesterase activity

Renal Dose Adjustments

Dose adjustment(s) may be required; however, no specific guidelines have been suggested.

Liver Dose Adjustments

Data not available

Precautions

CONTRAINDICATIONS:


Consult WARNINGS section for additional precautions.

Dialysis

Data not available

Other Comments

Administration advice:


General:
MILD SYMPTOMS:

SEVERE SYMPTOMS:

Patient advice:
Administer only after:

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.