Pralidoxime

Adult: In case IV pralidoxime administration is not feasible as an adjunct to atropine: Mild: 600 mg, may be repeated 1 or 2 times every 15 minutes if symptoms persist. Max total cumulative dose: 1,800 mg. If severe symptoms develop after the 1st dose, may give the 2 additional 600 mg doses in rapid succession for total cumulative dose of 1,800 mg. Severe: Three 600 mg inj given in rapid succession for a total cumulative dose of 1,800 mg. Persistent: May repeat the entire series (three 600 mg inj for total dose of 1,800 mg), starting approx 1 hour after administration of the last inj. Dosage recommendations may vary among individual products and between countries (refer to detailed product or local guidelines).
Child: In case IV pralidoxime administration is not feasible as an adjunct to atropine: Patients weighing <40 kg: Mild: 15 mg/kg/dose, may be repeated 1 or 2 times every 15 minutes if symptoms persist for total cumulative dose of 45 mg/kg. If severe symptoms develop after the 1st dose, may give the 2 additional doses in rapid succession for total cumulative dose of 45 mg/kg. Severe: Three 15 mg/kg/dose inj given in rapid succession for total cumulative dose of 45 mg/kg. Persistent: May repeat the entire series (three 15 mg/kg/dose inj for total dose of 45 mg/kg), starting approx 1 hour after administration of the last inj. ≥40 kg: Same as adult dose. All doses are inj into the anterolateral aspect of the thigh. Dosage recommendations may vary among individual products and between countries (refer to detailed product or local guidelines).

Adult: As adjunct to atropine: Administer as soon as the effects of atropine are observed. Loading dose: 1,000-2,000 mg (diluted to 10-20 mg/mL concentration) via IV infusion over 15-30 minutes. Alternatively, if infusion is not practical or pulmonary oedema occurs, may give the loading dose (diluted to 50 mg/mL concentration) via slow IV inj over at least 5 minutes. Doses may be repeated after 1 hour if muscle weakness is not relieved, then additional doses may be given every 10-12 hours if muscle weakness persists. Max intermittent infusion rate: 200 mg/min. Maintain atropinisation throughout therapy for at least 48 hours; large amount of atropine may be needed concomitantly. Dosage recommendations may vary among individual products and between countries (refer to detailed product or local guidelines).
Child: As adjunct to atropine: Administer as soon as the effects of atropine are observed. ≤16 years Loading dose: 20-50 mg/kg (Max: 2,000 mg/dose) via IV infusion over 15-30 minutes. Maintenance: 10-20 mg/kg/hour via continuous IV infusion. Alternative intermittent infusion dosing: 20-50 mg/kg (Max: 2,000 mg/dose) loading dose via IV infusion over 15-30 minutes. If muscle weakness is not relieved, another 20-50 mg/kg may be given after 1 hour if and may be repeated every 10-12 hours as needed. Max intermittent infusion rate: 200 mg/min. >16 years Same as adult dose. Dosage recommendations may vary among individual products and between countries (refer to detailed product or local guidelines).

Adult: For cases caused by drugs used to treat myasthenia gravis (e.g. neostigmine, pyridostigmine, ambenonium): Initially, 1,000-2,000 mg via IV infusion, followed by 250 mg increments every 5 minutes as necessary. Dosage recommendations may vary among individual products and between countries (refer to detailed product or local guidelines).