Systematic (IUPAC) name
Clinical data
AHFS/ Micromedex Detailed Consumer Information
Pregnancy cat. C
Legal status RX-only
CAS number 6735-59-7 YesY
ATC code V03AB04
PubChem CID 6789253
DrugBank APRD01193
ChemSpider 5193737 YesY
KEGG C07400 N
Synonyms 1-methylpyridine-6-carbaldehyde oxime
Chemical data
Formula C7H9N2O+
Mol. mass 137.159 g/mol
SMILES eMolecules & PubChem
 N(what is this?)  (verify)

Pralidoxime (2-pyridine aldoxime methyl chloride,) or 2-PAM, usually as the chloride or methiodide salts, belongs to a family of compounds called oximes that bind to organophosphate-inactivated acetylcholinesterase. It is used to combat poisoning by organophosphates[1] or acetylcholinesterase inhibitors (nerve agents), in conjunction with atropine and diazepam. In India, it is marketed by Nucleus Inc. with the brand names LyoPAM and PurePAM.


Mechanism of action

Pralidoxime, typically used in cases of organophosphate poisoning (causes ACHase inhibition), attaches to the site where a cholinesterase inhibitor has attached, then attaches to the inhibitor, removing the organophosphate from cholinesterase, allowing it to work normally again. This is known as "regenerating" or "reactivating" acetylcholinesterase allowing the breakdown of Ach at the synapse. After some time, though, some inhibitors can develop a permanent bond with cholinesterase, known as aging, where oximes such as pralidoxime can not reverse the bond.[2] Pralidoxime is often used with atropine (a muscarinic antagonist) to help reduce the parasympathetic effects of organophosphate poisoning. Pralidoxime can also be used to treat neostigmine or pyridostigmine (both ACHase inhibitors) overdoses due to it's ACHase inhibitor regenerating capacities.

Pralidoxime has an important role in reversing paralysis of the respiratory muscles but due to its poor blood-brain barrier penetration, it has little effect on centrally-mediated respiratory depression. This is why atropine which has excellent blood-brain barrier penetration, is concomitantly administered with pralidoxime during the treatment of organophosphate poisoning.


Intravenous infusions can lead to respiratory or cardiac arrest if given too quickly.[3]


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. This is especially true if the total dose of atropine has been large and the administration of pralidoxime has been delayed.

The following precautions should be kept in mind in the treatment of anticholinesterase poisoning, although they do not bear directly on the use of 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 patients with organophosphate poisoning.


There are no known absolute contraindications for the use of pralidoxime. Relative contraindications include known hypersensitivity to the drug and other situations in which the risk of its use clearly outweighs possible benefit.


Pralidoxime, 2-pyridinaldoxime methylchloride, is synthesized by reacting picolinaldehyde (2-formyl pyridine) with hydroxylamine, giving pyridine-2-aldoxime, which is further reacted with methyl iodide, giving the desired pralidoxime.

Pralidoxime synthesis.png

See also


External links