A1,
A2,
B,
C1,
C2,
D,
E,
F,
G-H,
I-K,
L,
M,
N,
O,
P1,
P2,
Q-R,
S,
T,
U-V,
W-Z
Protopam Side Effects, and Drug Interactions - Pralidoxime Chloride
Protopam Side Effects, and Drug Interactions - Pralidoxime Chloride
SIDE EFFECTS
Forty to 60 minutes after intramuscular injection, mild to moderate pain may
be experienced at the site of injection.
Pralidoxime may cause blurred vision, diplopia and impaired accommodation,
dizziness, headache, drowsiness, nausea, tachycardia, increased systolic and
diastolic blood pressure, hyperventilation, and muscular weakness when given
parenterally to normal volunteers who have not been exposed to anticholinesterase
poisons. In patients, it is very difficult to differentiate the toxic effects
produced by atropine or the organophosphate compounds from those of the drug.
Elevations in SGOT and/or SGPT enzyme levels were observed in 1 of 6 normal
volunteers given 1200 mg of pralidoxime chloride intramuscularly, and in 4 of
6 volunteers given 1800 mg intramuscularly. Levels returned to normal in about
2 weeks. Transient elevations in creatine phosphokinase were observed in all
normal volunteers given the drug. A single intramuscular injection of 330 mg
in 1 mL in rabbits caused myonecrosis, inflammation, and hemorrhage.
When atropine and pralidoxime are used together, the signs of atropinization
may occur earlier than might be expected when atropine is used alone. This is
especially true if the total dose of atropine has been large and the administration
of pralidoxime has been delayed. 2 - 4 Excitement
and manic behavior immediately following recovery of consciousness have been
reported in several cases. However, similar behavior has occurred in cases of
organophosphate poisoning that were not treated with pralidoxime. 3,5,6
DRUG ABUSE AND DEPENDENCE
Pralidoxime chloride is not subject to abuse and possesses no known potential
for dependence.
DRUG INTERACTIONS
When atropine and pralidoxime are used together, the signs of atropinization
(flushing, mydriasis, tachycardia, dryness of the mouth and nose) may occur
earlier than might be expected when atropine is used alone. This is especially
true if the total dose of atropine has been large and the administration of
pralidoxime has been delayed. 2 - 4
The following precautions should be kept in mind in the treatment of anticholinesterase
poisoning, although they do not bear directly on the use of pralidoxime: since
barbiturates are potentiated by the anticholinesterases, they should be used
cautiously in the treatment of convulsions; morphine, theophylline, aminophylline,
succinylcholine, reserpine, and phenothiazine-type tranquilizers should be avoided
in patients with organophosphate poisoning.
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