Indications & Dose: ANTICHOLINESTERASE POISONING Combination therapy IV Adult 1-2g followed by increments of 250mg q5min as needed with atropine before administration of pralidoxime | ORGANOPHOSPHATE POISONING Combination therapy IV Adult Loading dose: 1-2g, MD repeat bolus of 1-2g after 1h & repeat q10-12h thereafter as needed, alternatively, administer a loading dose of 30mg/kg followed by MD 8mg/kg/h (as inf) with atropine before administration of pralidoxime Child <16 yr: Loading dose: 20-50mg/kg max 2g/dose, MD 10-20mg/kg/h (as inf) or repeat bolus of 20-50mg/kg max 2g/dose after 1h & q10-12h thereafter as needed, >16 yr: Same as adult dose | Combination therapy IM/SC Adult Mild symptoms: 600mg repeat as needed for persistent mild symptoms q15min max total dose of 1.8g, may administer doses in rapid succession if severe symptoms develop, Severe symptoms: 600mg, repeat twice in rapid succession to deliver a total dose of 1.8g, Persistent symptoms: 1.8g 1h after administration of the last inj with atropine before administration of pralidoxime Child <40 kg: 15mg/kg repeat as needed for persistent mild symptoms q15min max total dose 45mg/kg, may administer doses in rapid succession if severe symptoms develop, Severe symptoms: 15mg/kg, repeat twice in rapid succession to deliver a total dose of 45mg/kg, Persistent symptoms: 45mg/kg 1h after administration of the last inj, >40 kg: Same as adult dose (IM/SC is considered when IV is not feasible) with atropine before administration of pralidoxime

Precautions: Myasthenia gravis, renal impairment

ADR: Serious: Cardiac arrest, HTN, tachycardia, ALT/AST increased, CPK increased, paralysis, blurred vision, diplopia, apnea, hyperventilation, laryngospasm, Others: renal function decreased, weakness, fasciculations, muscle rigidity, pain at Inj site, dizziness, drowsiness, headache, seizure, rash, nausea

Monitor: HR, respiratory rate, muscle fasciculations & strength, pulse oximetry, cardiac monitor, BP