Classes
DEA Class; Rx
Common Brand Names; ATNAA, DuoDote
- Cholinergic, Toxicity Antidotes
Description
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.
Indications
Indicated for treatment of poisoning by organophosphorus nerve agents as well as organophosphorus insecticides in adults and pediatric patients weighing >41 kg (90 pounds)
Adverse Effects
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
Warnings
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 and Lactation
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
Maximum Dosage
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