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USE OF PRALIDOXIME IN PREGNANCY

Date of issue: July 2022, Version: 2

Pralidoxime (1-methylpyridinium-2-aldoxime, 2-PAM) is an oxime drug used in conjunction with atropine in the treatment of poisoning due to organophosphorus (OP) insecticides or nerve agents.

Published data regarding the use of pralidoxime during pregnancy are limited to case reports describing a total of seven pregnancies. No adverse fetal effects have been reported, however available data are insufficient for accurate assessment of risk.

Where exposure to acetylcholinesterase inhibitors has occurred, maternal toxicity is likely to be a major determinant of risk to the fetus. Owing to the severity of complications associated with OP poisoning, treatment of the pregnant patient should be the same as for the non-pregnant patient. If pralidoxime use is clinically indicated, it should not be withheld due to pregnancy.

Enhanced antenatal surveillance may be warranted in all cases of poisoning and should be decided on a case-by-case basis. Discussion with UKTIS is recommended in all cases of exposure to pralidoxime at any stage of pregnancy.

This is a summary of the full UKTIS monograph for health care professionals and should not be used in isolation. The full UKTIS monograph and access to any hyperlinked related documents is available to NHS health care professionals who are logged in.

If you have a patient with exposure to a drug or chemical and require assistance in making a patient-specific risk assessment, please telephone UKTIS on 0344 892 0909 to discuss the case with a teratology specialist.

If you would like to report a pregnancy to UKTIS please click here to download our pregnancy reporting form. Please encourage all women to complete an online reporting form.

Disclaimer: Every effort has been made to ensure that this monograph was accurate and up-to-date at the time of writing, however it cannot cover every eventuality and the information providers cannot be held responsible for any adverse outcomes of the measures recommended. The final decision regarding which treatment is used for an individual patient remains the clinical responsibility of the prescriber. This material may be freely reproduced for education and not for profit purposes within the UK National Health Service, however no linking to this website or reproduction by or for commercial organisations is permitted without the express written permission of this service. This document is regularly reviewed and updated. Only use UKTIS monographs downloaded directly from UKTIS.org to ensure you are using the most up-to-date version.