Pralidoxime Chloride

Adults: Adults and children over 16 years: Give an initial dose of 1000 to 2000 mg of Pralidox (Pralidoxime Chloride), preferably as an infusion in 100 ml of normal saline over 15 to 30 minutes. If this is not practical, or if pulmonary oedema is present, give the dose slowly by intravenous injection (over not less than 5 minutes) as a 50 mg/ml solution (for example, 1000 mg in 20 ml). A second dose of 1000 to 2000 mg may be needed after about one hour if muscle weakness has not been relieved. Further doses may be given every 10 to 12 hours if muscle weakness persists. Children 16 years and under: Loading dose: 20 to 50 mg/kg (maximum 2000 mg per dose) over 15 to 30 minutes. Maintenance infusion: 10 to 20 mg/kg per hour. Alternatively, a repeat bolus of 20 to 50 mg/kg (maximum 2000 mg per dose) may be given after 1 hour and repeated every 10 to 12 hours thereafter, as needed. Preparation for administration: For intravenous infusion, reconstitute a single Pralidox (Pralidoxime Chloride) 1000 mg vial by adding 20 ml of Normal Saline (0.9% Sodium Chloride solution) for Injection using a 10 ml syringe; this gives a concentration of 50 mg/ml. Dilute the solution further with the remaining Normal Saline to reach a concentration of 10 to 20 mg/ml (for example, 1000 mg in 100 ml or 2000 mg in 100 ml). For fluid-restricted patients, or for rapid administration (over at least 5 minutes), a maximum concentration of 50 mg/ml may be used. Discard any unused solution once the dose has been withdrawn.