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Atropine/Pralidoxime

    DEA Class;  Rx

    Common Brand Names; ATNAA, DuoDote

    • Cholinergic, Toxicity Antidotes

    Parenteral cholinesterase reactivator; antidote to reverse muscle paralysis from organophosphate anticholinesterase poisoning or overdose of drugs used for myasthenia gravis; atropine must be administered concomitantly.

    Indicated for treatment of poisoning by organophosphorus nerve agents as well as organophosphorus insecticides in adults and pediatric patients weighing >41 kg (90 pounds)

     

    Injection site reaction (muscle tightness, pain)

    Atropine

    • Dry mouth
    • Blurred vision
    • Dry eyes
    • Photophobia
    • Confusion
    • Headache
    • Dizziness

    Pralidoxime

    • Vision changes
    • Dizziness, headache
    • Drowsiness
    • Nausea
    • Tachycardia
    • Increased blood pressure
    • Muscular weakness
    • Dry mouth
    • Emesis
    • Rash
    • Dry skin
    • Hyperventilation
    • Decreased renal function
    • Manic behavior
    • Transient elevation of LFTs

    Caution in patients with known cardiovascular disease or cardiac conduction problems

    May inhibit sweating and lead to hyperthermia; avoid excessive exercise and heat exposure

    Caution in susceptible individuals at risk for acute glaucoma

    Caution in patients with bladder outflow obstruction owing to risk of urinary retention

    Caution with partial pyloric stenosis because of risk of complete pyloric obstruction

    May cause inspiration of bronchial secretions and formation of dangerous viscid plugs in individuals with chronic lung disease; monitor respiratory status

    Individual should not rely solely upon atropine and pralidoxime to provide complete protection from chemical nerve agents and insecticide poisoning (eg, primary protection is the wearing of protective garments)

    Elderly individuals may be more susceptible to the effects of atropine

    Patients with organophosphorus nerve agent or organophosphorus insecticide poisoning who have received atropine/pralidoxime may exhibit accelerated reversal of the neuromuscular blocking effects of succinylcholine and mivacurium; monitor for neuromuscular effects with concomitant succinylcholine or mivacurium use

    Pregnancy

    Atropine readily crosses the placental barrier and enters fetal circulation; there are no adequate data on developmental risk associated with use of atropine, pralidoxime, or combination in pregnant women

    Lactation

    Atropine has been reported to be excreted in human milk; unknown whether pralidoxime is excreted in human milk

    Adults

    Not to exceed 3 injections unless medical care support available

    3 autoinjectors should be available for use in each patient (including healthcare providers) at risk for organophosphorus poisoning; use 1 for mild symptoms plus 2 more for severe symptoms

    Pediatric

    Not to exceed 3 injections unless medical care support available

    3 autoinjectors should be available for use in each patient (including healthcare providers) at risk for organophosphorus poisoning; use 1 for mild symptoms plus 2 more for severe symptoms

    Pralidoxime Chloride/Atropine Sulphate

    IM autoinjector

    • atropine (2.1mg/0.7mL) plus pralidoxime chloride (600mg/2mL) in 2 separate chambers; when activated, sequentially administers both drugs IM through a single needle