프랄리독심 염화물
Pralidoxime Chloride
2-Formyl-1-methylpyridinium chloride oxime
다른 이름: Protopam Chloride · 2-Formyl-1-methylpyridinium chloride oxime · 2-PAM chloride · 2-PAMCl · 2-pyridine aldoxime methochloride
VetSheet 수의사 팀 검수업데이트 2026년 4월 5일근거 기반 수의학 참고자료
용량은 수의사 전문가를 위한 임상 참고자료입니다. 반드시 최신 약물 정보 및 개별 환자에 따라 확인하시기 바랍니다.
동물 종별 용량
🌎 NA — North America🌍 EU — Europe
개
| 적응증 | 용량 | 경로 | 빈도 | 기간 | 지역 |
|---|---|---|---|---|---|
| Organophosphate poisoning | 20 mg/kg | IM or slow IV | 2-3 times a day | — | 🌎 NA |
| Organophosphate poisoning | 10-15 mg/kg | IM or SC | q8-12h | 36 hour minimum | 🌎 NA |
| Organophosphate poisoning | 50 mg/kg | slow IV | May repeat in one hour if severe | Recovery should occur gradually over 48 hours | 🌎 NA |
| Organophosphate poisoning | 50 mg/kg | IV | Repeat in one hour if signs persist, then q8h | 24-48 hours | 🌎 NA |
- Organophosphate poisoning: Works best when combined with atropine. Initial dose IM or slow IV; subsequent doses IM or SC.
- Organophosphate poisoning: Give atropine first (0.1 mg/kg IV, then 0.3 mg/kg IM). Dilute pralidoxime in 10% glucose. For small dogs, may administer IM or IP. Reduce dose in renal failure.
- Organophosphate poisoning: Give slowly or with fluids over a 30-minute period. If clinical signs intensify (e.g., respiratory depression), reduce dose and give as repeated one-hour infusions every 4-8 hours in combination with atropine.
고양이
| 적응증 | 용량 | 경로 | 빈도 | 기간 | 지역 |
|---|---|---|---|---|---|
| Organophosphate poisoning | 20 mg/kg | IM or slow IV | 2-3 times a day | — | 🌎 NA |
| Organophosphate poisoning | 10-15 mg/kg | IM or SC | q8-12h | 36 hour minimum | 🌎 NA |
| Organophosphate poisoning | 50 mg/kg | slow IV | May repeat in one hour if severe | Recovery should occur gradually over 48 hours | 🌎 NA |
| Organophosphate poisoning | 20 mg/kg | IV | Repeat in one hour if signs persist, then q8h | 24-48 hours | 🌎 NA |
| Organophosphate poisoning | 20 mg/kg | IM or IV | May repeat q6-8h | — | 🌎 NA |
- Organophosphate poisoning: Works best when combined with atropine. Initial dose IM or slow IV; subsequent doses IM or SC.
- Organophosphate poisoning: Give atropine first. Dilute in 10% glucose. May administer IM or IP. Reduce dose in renal failure.
- Organophosphate poisoning: Give slowly or with fluids over a 30-minute period.
- Organophosphate poisoning: Give within first 24 hours of exposure. Combine with atropine or give separately. Do not use in carbamate toxicity.
새
| 적응증 | 용량 | 경로 | 빈도 | 기간 | 지역 |
|---|---|---|---|---|---|
| Organophosphate poisoning | 10-20 mg/kg | Not specified | q8-12h | — | 🌎 NA |
| Organophosphate poisoning | 10-100 mg/kg | IM | q24-48h or repeat once in 6 hours | — | 🌎 NA |
- Organophosphate poisoning: Give with atropine (0.2-0.5 mg/kg IM q3-4h).
말
| 적응증 | 용량 | 경로 | 빈도 | 기간 | 지역 |
|---|---|---|---|---|---|
| Organophosphate poisoning | 20 mg/kg (may require up to 35 mg/kg) | IV | q4-6h | — | 🌎 NA |
소
| 적응증 | 용량 | 경로 | 빈도 | 기간 | 지역 |
|---|---|---|---|---|---|
| Organophosphate poisoning | 30 mg/kg | IM | q8h | — | 🌎 NA |
| Organophosphate poisoning | 25-50 mg/kg | IV | Single dose, or maximum of 100 mg/kg/day as an IV drip | — | 🌎 NA |
- Organophosphate poisoning: FARAD recommends a 28-day meat and a 6-day milk withdrawal time.
- Organophosphate poisoning: Give as a 20% solution over 6 minutes.
용량은 수의사 전문가를 위한 임상 참고자료입니다. 반드시 최신 약물 정보 및 개별 환자에 따라 확인하시기 바랍니다.
개요
프랄리독심(흔히 2-PAM으로 불림)은 수의학에서 주로 유기인계(OP) 중독을 치료하는 데 사용되는 특이적 해독제입니다. 유기인계 화합물은 구형 살충제, 농약 및 일부 신경 작용제에서 흔히 발견됩니다. 이들은 아세틸콜린에스테라아제(AChE)에 비가역적으로 결합하고 억제하여 신경 시냅스와 신경근 접합부에 아세틸콜린이 대량으로 축적되게 합니다.
프랄리독심은 콜린에스테라아제 재활성화제로 작용하여, 결합이 영구적으로 변하기 전(이 과정을 "노화(aging)"라고 함)에 효소에서 유기인계 분자를 효과적으로 떼어냅니다.
임상 요점: 프랄리독심은 거의 항상 아트로핀과 함께 사용됩니다. 아트로핀은 아세틸콜린 과다로 인한 무스카린성 효과(SLUDDE 증상: 유연, 눈물, 배뇨, 배변, 호흡곤란, 구토)를 차단하는 반면, 프랄리독심은 니코틴성 효과(특히 심각한 근육 떨림, 쇠약 및 호흡근을 포함한 마비)를 완화하는 데 필요합니다. 카바메이트 중독의 경우 카바메이트-AChE 결합이 옥심계 재활성화제 없이도 자발적으로 가역화되므로 일반적으로 권장되지 않습니다.
작용 기전
Pralidoxime works by directly reactivating the acetylcholinesterase enzyme that has been inhibited by organophosphates.
- Organophosphates bind to the esteratic site of acetylcholinesterase (AChE) via phosphorylation, inactivating the enzyme.
- Accumulation of acetylcholine (ACh) occurs at muscarinic and nicotinic receptors → severe overstimulation.
- Pralidoxime possesses a high affinity for the AChE enzyme.
- Via nucleophilic attack, the oxime group of pralidoxime binds to the offending phosphoryl group of the organophosphate.
- The pralidoxime-organophosphate complex breaks away from the enzyme → AChE is reactivated and resumes breaking down ACh.
Important Mechanistic Note: If the phosphorylated enzyme undergoes a chemical change (loss of an alkyl group) before pralidoxime is administered, the bond becomes permanent. This is known as "aging". Therefore, pralidoxime is most effective when given within 24 hours of exposure, though some benefit may be seen up to 36-48 hours in massive exposures.
안전성·주의사항
금기사항
- Hypersensitivity to pralidoxime
- Carbamate poisoning (generally not recommended as inhibition is rapidly reversible)
부작용
- Tachycardia (especially with rapid IV injection)
- Muscle rigidity
- Transient neuromuscular blockade
- Laryngospasm
주의
Use with caution in patients receiving anticholinesterase agents for the treatment of myasthenia gravis, as it may precipitate a myasthenic crisis. Use cautiously and at a reduced dosage rate in patients with renal impairment. Must generally be given within 24 hours of exposure to be effective. Rapid IV injection should be avoided to prevent tachycardia, muscle rigidity, and laryngospasm.
약물 상호작용
Anticholinesterases can potentiate the action of barbiturates; use with caution.
Use should be avoided in patients with organophosphate toxicity.
Use should be avoided in patients with organophosphate toxicity.
Use should be avoided in patients with organophosphate toxicity.
Use should be avoided in patients with organophosphate toxicity.
Use should be avoided in patients with organophosphate toxicity.
모니터링
- Clinical signs associated with organophosphate poisoning (SLUDDE signs, muscle fasciculations, weakness)
- Heart rate and rhythm (especially during IV administration)
- Respiratory rate and effort
약동학
흡수
Marginally absorbed after oral dosing; oral dosage forms are no longer available in the United States.
분포
Distributed primarily throughout the extracellular water. Because of its quaternary ammonium structure, it is historically not believed to enter the CNS in significant quantities, but recent studies and clinical responses have led some to question this belief.
대사
Thought to be metabolized by the liver.
배설
Excreted as both metabolite(s) and unchanged drug in the urine.
과다투여
The acute LD50 of pralidoxime in dogs is 190 mg/kg. At high dosages, it causes signs associated with its own anticholinesterase activity.
Clinical signs of toxicity in dogs may be exhibited as:
- Muscle weakness
- Ataxia
- Vomiting
- Hyperventilation
- Seizures
- Respiratory arrest
- Death
제품
제형
- Powder for injection
인용의약품
- Pralidoxime Chloride Powder for Injection: 1 gram in 20 mL single-use vials (Protopam Chloride)
규제 현황
규제 데이터 없음: 🇺🇸 US · 🇪🇺 EU · 🇬🇧 UK · 🇭🇰 HK · 🇹🇼 TW · 🇯🇵 JP · 🇰🇷 KR · 🇦🇺 AU
보관·안정성
Unless otherwise instructed by the manufacturer, pralidoxime chloride powder for injection should be stored at room temperature. After reconstituting with sterile water for injection, the solution should be used within a few hours. Do not use sterile water with preservatives added.
보호자 정보
- 응급 치료: 이 약물은 특정 유형의 농약이나 신경 작용제(유기인계) 중독에 대한 매우 중요한 응급 해독제입니다.
- 입원 필요: 반려동물은 이 약물을 투여받는 동안 입원하여 수의학 전문가의 면밀한 모니터링을 받아야 합니다.
- 시간 민감성: 이 해독제는 노출 후 가능한 한 빨리(이상적으로는 처음 24시간 이내에) 투여할 때 가장 효과적입니다.
- 병용 요법: 심각한 중독 증상을 완전히 조절하기 위해 거의 항상 아트로핀이라는 다른 해독제와 함께 투여됩니다.
VetSheet 의약품 참고자료는 수의사 전문가의 임상 의사결정 지원을 위한 것이며, 전문적 판단이나 제조사의 최신 약물 정보를 대체할 수 없습니다.