Atropine and pralidoxime

Name: Atropine and pralidoxime

Atropine and pralidoxime side effects

Some of the side effects of atropine and pralidoxime may be similar to the symptoms of poisoning. Your caregivers will watch you closely to determine whether your body is responding well to the medication, or if you are having any serious side effects.

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Tell your caregivers at once if you have a serious side effect such as:

  • pounding heartbeats or fluttering in your chest;

  • painful or difficult urination;

  • trouble swallowing;

  • feeling like you might pass out;

  • confusion;

  • loss of movement in any part of your body;

  • slow heart rate, weak pulse, fainting, slow breathing (breathing may stop); or

  • chest pain or heavy feeling, pain spreading to the arm or shoulder, nausea, sweating, general ill feeling.

Less serious side effects may include:

  • dry mouth, dry nose, dry skin;

  • dry eyes, blurred vision;

  • increased sensitivity of your eyes to light;

  • headache;

  • dizziness, drowsiness;

  • muscle weakness;

  • constipation, stomach pain, bloating, nausea, vomiting;

  • loss of interest in sex, impotence; or

  • mild skin rash.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

Indications and usage

The ATNAA is indicated for the treatment of poisoning by susceptible organophosphorous nerve agents having anticholinesterase activity.


General: The desperate condition of the organophosphorous-poisoned patient will generally mask such minor signs and symptoms of Atropine and Pralidoxime treatment as have been noted in normal subjects.

Because pralidoxime is excreted in the urine, a decrease in renal function will result in increased blood levels of the drug.

The ATNAA should be used with caution in all individuals over 40 years of age. Conventional systemic doses may precipitate acute glaucoma in susceptible patients, convert partial organic pyloric stenosis into complete pyloric obstruction, precipitate urinary retention in patients with prostatic hypertrophy, or cause inspiration of bronchial secretions and formation of dangerous viscid plugs in patients with chronic lung disease.

Information for Patients: Appropriate steps must be taken to insure that personnel understand the indications for, and use of, the ATNAA, including review of symptoms of poisoning and operation of the ATNAA (see DOSAGE AND ADMINISTRATION and Patient Instruction Sheet).

Drug Interactions: When Atropine and Pralidoxime are used together, the signs of atropinization (flushing, mydriasis, tachycardia, dryness of the mouth and nose) may occur earlier than might be expected when atropine is used alone because pralidoxime may potentiate the effect of atropine.2,3,4

The following precautions should be kept in mind in the treatment of anticholinesterase poisoning, although they do not bear directly on the use of Atropine and Pralidoxime. Since barbiturates are potentiated by the anticholinesterases, they should be used cautiously in the treatment of convulsions. Morphine, theophylline, aminophylline, succinylcholine, reserpine, and phenothiazine- type tranquilizers should be avoided in treating personnel with organophosphorous poisoning.

Carcinogenesis, Mutagenesis, Impairment of Fertility: No reports regarding the potential of atropine or pralidoxime chloride for carcinogenesis, mutagenesis, or impairment of fertility have been published in the literature. Since the ATNAA is indicated for short-term emergency use only, no investigations of these aspects have been conducted.

Pregnancy: Teratogenic Effects - Pregnancy Category C: Adequate animal reproduction studies have not been conducted with atropine, pralidoxime, or the combination. It is not known whether pralidoxime or atropine can cause fetal harm when administered to a pregnant woman or if these agents can affect reproductive capacity. The ATNAA should be administered to a pregnant woman only if clearly needed.

Nursing Mothers: It is not known whether these drugs are excreted in human milk. Because many drugs are excreted in human milk, caution should be exercised when the ATNAA is administered to a nursing woman.

Pediatric Use: Safety and effectiveness in pediatric patients have not been established.

Index Terms

  • Atropine and Pralidoxime Chloride
  • Mark 1
  • NAAK
  • Nerve Agent Antidote Kit
  • Pralidoxime and Atropine

Dosing Geriatric

Refer to adult dosing. No dosing adjustment recommended.


ATNAA: May be administered in the lateral thigh muscle or buttocks. The first dose may be self-administered; subsequent doses must be administered by a buddy. Remove the gray safety cap from the back end; place the front end on the outer thigh or buttocks and push hard to activate the injector. Hold firmly in place for 10 seconds. After use, bend the needle into a hook shape against a hard surface.

Duodote: Self-administration: Hold the device firmly at the center with the green tip (needle end) pointing down; remove the gray safety release with the other hand; do not touch the green tip at any time. The device is ready for administration into the mid-outer thigh; removal of clothing is not necessary, but pockets should be empty. Swing at a 90° angle to allow the green tip to push against the mid-outer thigh. Hold firmly in place until auto-injector triggers and an additional 10 seconds after device has triggered. After administration, the needle will be visible; if the needle is not visible, repeat the above steps. After use, bend the needle against a hard surface (needle does not retract) to avoid accidental injury.

Adverse Reactions

Frequency not defined. Reactions reported with Duodote. Also see individual agents.

Cardiovascular: Transient increase of blood pressure (usually occurring 15 minutes after administration and returning to baseline 4 hours post-dose)

Central nervous system: Hypertonia (at injection site; mild-to-moderate)

Local: Pain at injection site (mild-to-moderate)

Monitoring Parameters

Respiratory status, ABGs, pulse oximeter; body temperature (especially in warm climates); blood pressure (peak effect occurs ~15 minutes after administration); symptoms of poisoning

For the Consumer

Applies to atropine / pralidoxime: intramuscular solution auto-injector

Renal Dose Adjustments

Data not available