pralidoxime 600 mg/2 mL intramuscular pen injector


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Medication name

Generic name:
Pralidoxime auto-injector - injection



This medication is used with atropine to treat nerve agent poisoning by certain chemicals known as anticholinesterase agents (such as organophosphate pesticides such as parathion, "nerve gas" such as sarin, other nerve agents such as VX). Pralidoxime works by restoring the activity of a certain natural substance (cholinesterase) needed by nerves and muscles. Symptoms of nerve agent poisoning may include trouble breathing, headache, runny nose, drooling, vision changes, sweating, abdominal cramps, nausea, vomiting, diarrhea, muscle twitching/jerking, drowsiness, confusion, and seizures.

Pralidoxime works mostly on the muscles (including breathing muscles) to decrease twitching, cramping, weakness, and paralysis. Another medication (atropine) is used to treat these and other symptoms of nerve agent poisoning such as slow/shallow breathing, wheezing, increased sweating/saliva, abdominal cramps, vomiting, and diarrhea.

How to use

Talk with your doctor about when you should use this product. Know the symptoms of nerve agent poisoning. (See also Uses section.)

Learn how to properly inject this medication in advance so you will be prepared if you actually need to use it. Also teach another person what to do in case you cannot inject the medication yourself.

This medication is given by injection into the muscle of the outer thigh, through clothing if necessary, as soon as possible after exposure to a nerve agent. Another drug (atropine) is usually injected first. Inject this drug (pralidoxime) after the atropine. Hold the injector firmly in place for 10 seconds. Massage the area of injection.

To prevent further exposure to poison, the victim (and any others who treat or have contact with the victim) must right away put on protective equipment (such as breathing mask, gloves) and perform rapid decontamination procedures (such as removing contaminated clothing, washing skin and hair with sodium bicarbonate or alcohol).

Pralidoxime is most effective when used within 24 hours after exposure. If symptoms of poisoning (such as increase in saliva, difficulty breathing, muscle weakness) are still present 15 minutes after the injections, you may give another dose of both atropine and pralidoxime. If needed, you may give a third set of injections 15 minutes later.

Get medical help right away for follow-up treatment. Do not give more than 3 injections unless directed by a doctor.

Dosage is based on your medical condition and poisoning symptoms.

Side effects

Dizziness, drowsiness, or pain at the injection site may occur. Normal effects from atropine include flushing, large pupils, fast heartbeat, and dryness of the mouth and nose. If any of these effects persist or worsen, tell your doctor, pharmacist, or other health care professional promptly.

Remember that your doctor has prescribed this medication because he or she has judged that the life-saving benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.

A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including:

  • rash
  • itching/swelling (especially of the face/tongue/throat)
  • worsening dizziness
  • worsening trouble breathing

This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.

In the US -

Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at

In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.


Before using pralidoxime, tell your doctor or pharmacist if you are allergic to it; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.

Before using this medication, tell your doctor or pharmacist your medical history, especially of:

  • kidney disease
  • a certain nerve/muscle problem (myasthenia gravis)

This drug may make you dizzy or drowsy. Alcohol or marijuana (cannabis) can make you more dizzy or drowsy. Do not drive, use machinery, or do anything that needs alertness until you can do it safely. Avoid alcoholic beverages. Talk to your doctor if you are using marijuana (cannabis).

During pregnancy, this medication should be used only when clearly needed. Discuss the risks and benefits with your doctor.

It is unknown if this drug passes into breast milk. Consult your doctor before breast-feeding.

Drug interactions

Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.


If this drug is injected accidentally without exposure to a nerve agent or if someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center. In people not exposed to nerve agents, symptoms of overdose may include: dizziness, vision problems, headache, nausea, fast heartbeat.


After first-aid treatment and decontamination, more treatment in a hospital is usually needed. Consult your doctor for more details.

Missed dose

Not applicable.


Store at room temperature away from light and moisture. Do not store in the bathroom. Keep all medications away from children and pets.

From time to time, check the expiration date, and also check this product visually for particles or discoloration. Replace the unit before it expires or if particles/discoloration are present.

Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this medication when it is expired, used, or no longer needed. Consult your pharmacist or local waste disposal provider.

Important note

HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.

Information last revised October 2018.

Selected from NATIONAL DRUG DATA FILE (NDDF) data included with permission and copyrighted by First Databank, Inc., 2019. This copyrighted material has been downloaded from a licensed data provider.

The above information is intended to supplement, not substitute for, the expertise and judgment of your health care professional. You should consult your health care professional before taking any drug, changing your diet, or commencing or discontinuing any course of treatment.