Cholinesterase reactivator (oxime)
Pralidoxime chloride
Adult dose
Dose: 30 mg/kg IV over 20 min, then 8 mg/kg/h infusion (severe organophosphate poisoning)
Route: IV
Frequency: per indication
Clinical pearls
- Organophosphate poisoning — use with atropine
- Best within 24h of exposure (aged enzyme-OP complex resistant)
Contraindications
- Hypersensitivity
- Carbamate poisoning (relative)
Side effects
- Tachycardia
- Hypertension
- Headache
- Blurred vision
- Hyperventilation
Monitoring
- Cholinesterase activity
- BP
- HR
Reference: BNF; TOXBASE; https://bnf.nice.org.uk/drugs/pralidoxime-chloride/. Verify against your local formulary and the latest BNF before prescribing.
Related
Curated clinical cross-links plus same-class fallbacks.
Pathways
- New-Onset Atrial Fibrillation · ESC 2020 AF Guidelines; NICE NG196
- Hypertensive Emergency · ESC/ESH 2018 Hypertension Guidelines; NICE NG136
- Bradycardia Management · Resuscitation Council UK ABCDE; ESC 2021 Pacing Guidelines
- Ventricular Tachycardia / Fibrillation · Resuscitation Council UK ACLS; ESC 2022 Ventricular Arrhythmia Guidelines
- Syncope Assessment · ESC 2018 Syncope Guidelines; NICE NG109
- Acute Chest Pain · NICE CG95; ESC 2023 ACS Guidelines