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Nerve Agent Exposure > Drug Therapy Author: Elliot Rodriguez, MD, FACEP; Christine M. Stork, PharmD, DABAT
Editorial changes - 2009-12-01
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Rationale:

  • 2-pralidoxime is the only available oxime in the U.S.
  • Oximes regenerate AChE at both muscarinic and nicotinic sites by binding to the nerve agent, and they should be employed as early as possible after exposure in order to avoid aging (irreversible binding) of the toxin to the AChE enzyme.

Evidence:

  • A letter describes the use of pralidoxime infusions (31).
  • A computer simulation trial shows that pralidoxime at 0.5 g/h maintains a therapeutic concentration >4 µg/mL for a longer period of time than standard dosing (32).
  • A single case report discusses a patient exposed to an organophosphate who was treated with a continuous infusion of pralidoxime with a favorable outcome (33).
  • A review article on biological and chemical weapons of mass destruction disorders discusses the use of pralidoxime (34).

Comments:

  • Nebulized ipratropium bromide, 500 µg 3 to 4 times daily, can be used as an adjunct in treating nerve agent-induced bronchospasm (35).

FAQs
Christine M. Stork, PharmD, DABAT has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations. Elliot Rodriguez, MD, FACEP has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations. Jerrold B. Leikin, MD, editorial consultant, received royalties from McGraw-Hill, Taylor and Francis; editor of Toxicoterrorism (McGraw-Hill).
Darren B. Taichman, MD, PhD, Editor, PIER, has received grant support from Actelion Pharmaceuticals Ltd , and honoraria for continuing medical education grand rounds and lectures given.

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