Atropine / Pralidoxime
Atropine and pralidoxime chloride is an emergency combination antidote used to treat poisoning by organophosphorus nerve agents and, for DuoDote, organophosphorus insecticides.
🧬 Where this information comes from Click to expand
The clinical label records used on this page are FDA-filed Structured Product Labeling (SPL) retrieved through openFDA. We identified 2 clinical label sets within the page’s selected clinical scope after exact ingredient or ingredient-combination matching and applicable route/form matching. Forms, routes, brands, labelers, strengths, and NDC product-record counts are built separately from matching FDA National Drug Code Directory records. The linked DailyMed document is a representative official source for verification, not the page’s only clinical source. View the linked label on DailyMed →
📖 Atropine / Pralidoxime: Patient Information Guide
A plain-language walkthrough of Atropine / Pralidoxime — what it treats, how it works, how it’s taken, side effects, warnings and interactions. Tap any section to expand it.
🎯What it's used for▾
Atropine and pralidoxime chloride is an emergency antidote combination available in two auto-injector products with related but distinct approved uses:
- DuoDote (intramuscular auto-injector) is used to treat poisoning by organophosphorus nerve agents and organophosphorus insecticides in adults and pediatric patients weighing more than 41 kg (90 pounds).
- ATNAA (intramuscular auto-injector) is used to treat poisoning by susceptible organophosphorus nerve agents in adults only — it is not approved for insecticide poisoning.
- Both products are intended as initial emergency treatment only — definitive medical care must be sought immediately after use.
⚙️How it works▾
Organophosphorus nerve agents work by blocking an enzyme called acetylcholinesterase, causing a dangerous buildup of the chemical messenger acetylcholine throughout the body. Atropine counters this by blocking the receptors that acetylcholine overstimulates — reducing excessive secretions, relieving airway tightening, and protecting the heart from dangerously slow rates. Pralidoxime chloride attacks the problem at the source: it reactivates the acetylcholinesterase enzyme that the nerve agent has deactivated, helping restore normal nerve signaling — most critically in the muscles that control breathing.
Importantly, pralidoxime chloride does not work against all nerve agents (for example, it cannot reactivate the enzyme after exposure to soman), and it loses effectiveness if the enzyme has undergone a chemical change called "aging." This is why treatment must begin as soon as symptoms appear.
💊How it's taken▾
Both DuoDote and ATNAA are given as intramuscular injections into the outer thigh using a single-dose auto-injector — they are not taken by mouth. The number of injections depends on symptom severity at the time of exposure.
- DuoDote: One injection for two or more mild symptoms; up to three injections (given in rapid succession) for severe symptoms. Administered into the mid-lateral thigh.
- ATNAA: One injection for mild symptoms (self-administered); up to three total injections for severe symptoms (additional injections given by a buddy). Administered into the lateral thigh or buttocks.
- Both products are emergency treatments — always seek definitive medical care immediately after use and remain under close medical supervision for at least 48–72 hours.
🤒Side effects — in detail▾
Both atropine and pralidoxime chloride carry their own side effect profiles, and when combined, atropine's effects may appear sooner and more strongly.
- Dry mouth, blurred vision, dry eyes, sensitivity to light
- Confusion, headache, dizziness
- Rapid heart rate (tachycardia), palpitations, flushing
- Nausea, vomiting, constipation, abdominal discomfort
- Difficulty urinating
- Changes in blood pressure (pralidoxime can temporarily raise it)
- Muscle weakness, drowsiness
- Pain or tightness at the injection site
Seek immediate medical attention for signs of severe heart rhythm problems, very high fever, sudden eye pain, inability to urinate, hallucinations, or loss of consciousness — these are signs of serious reactions that need urgent care.
⚠️Warnings & precautions▾
- Heart risks: Atropine can cause rapid heart rate, abnormal rhythms, and in people with heart disease or a recent heart attack, it may trigger more serious cardiac events including heart attack. Use with caution in anyone with cardiovascular disease.
- Heat injury: Atropine reduces sweating, which can lead to dangerous overheating — especially in warm environments or with exercise. Avoid excessive heat and strenuous activity after treatment when possible.
- Acute glaucoma: Atropine can trigger acute angle-closure glaucoma (a sudden, painful rise in eye pressure) in susceptible individuals.
- Urinary retention: Atropine can make it difficult or impossible to urinate, particularly in people with existing bladder outflow problems.
- Chronic lung disease: Atropine can thicken airway secretions and create dangerous mucus plugs in people with chronic lung conditions. Breathing should be closely monitored.
- Pyloric stenosis: In people with partial stomach outlet narrowing, atropine may cause complete blockage.
- Kidney and liver impairment: Patients with severe kidney or liver disease may require less frequent dosing after the initial injection.
🔀What it interacts with▾
There is one key drug interaction to be aware of with this combination:
- Succinylcholine and mivacurium (muscle relaxants used during anesthesia and medical procedures): Because pralidoxime reactivates the enzyme that breaks down these drugs, their muscle-relaxing effects may wear off faster than expected. Medical staff should monitor closely if these drugs are used in someone who has received ATNAA or DuoDote.
This is not a complete list of interactions. Always talk with your doctor or pharmacist before starting, stopping, or changing any medication.
📋Before taking it▾
- Tell your provider about any history of heart disease, heart rhythm problems, or recent heart attack — atropine can worsen these conditions.
- Mention if you have bladder outflow obstruction or trouble urinating — atropine increases urinary retention risk.
- Mention if you have partial pyloric stenosis (stomach outlet narrowing) — atropine may cause complete obstruction.
- Tell your provider if you are at risk for glaucoma — atropine may trigger acute angle-closure glaucoma.
- People with chronic lung disease need close respiratory monitoring after receiving these medicines.
- Older adults are more sensitive to atropine's effects and should be monitored carefully.
- Atropine crosses the placenta and is found in breast milk — the risks and benefits must be weighed carefully in pregnant or breastfeeding individuals.
- DuoDote is not established as safe or effective in pediatric patients weighing 41 kg (90 pounds) or less. ATNAA is approved for adults only.
- Severe kidney impairment: pralidoxime can reduce kidney function further, and less frequent dosing may be needed after the initial dose.
- Severe liver impairment: less frequent dosing may also be needed after the initial dose.
🚑If you take too much▾
Too much atropine can cause flushing, very high fever, widely dilated pupils, rapid heart rate, severe confusion, hallucinations, delirium, and in extreme cases, coma or respiratory collapse. Too much pralidoxime can cause dizziness, blurred vision, headache, nausea, and a temporary rise in blood pressure lasting several hours. Treatment of atropine overdose is supportive — maintaining breathing (with artificial respiration if needed), controlling body temperature with cooling measures, maintaining urine output, and using benzodiazepines cautiously if seizures or severe agitation occur. Barbiturates should be used with caution, and stimulant medications are not recommended.
📡Pharmacodynamics — effects in the body▾
Atropine reduces secretions in the mouth and airways, relieves airway constriction, and increases heart rate — countering the dangerous slowing and flooding of secretions caused by nerve agent poisoning. It may also reduce fever-producing sweating, which can paradoxically cause overheating. Pralidoxime chloride's most critical action is relieving paralysis of the respiratory muscles. It has a smaller role in reducing other nerve agent symptoms like excessive saliva or airway spasm. When given as the ATNAA auto-injector, pralidoxime temporarily raises both systolic and diastolic blood pressure, with levels peaking around 15 minutes after injection and returning to near-baseline within about four hours.
🔬Pharmacokinetics — how your body processes it▾
Both atropine and pralidoxime chloride are well absorbed after intramuscular injection. Following a DuoDote injection, atropine reaches stable blood levels within about 5 minutes and maintains them through 60 minutes; its half-life (the time for half the drug to leave the body) is approximately 2.4 hours in healthy adults, but significantly longer — around 10 hours — in older adults aged 65–75. Pralidoxime chloride is absorbed rapidly, with peak levels reached around 28 minutes after injection; its half-life is approximately 2 hours. Both drugs are cleared primarily through the kidneys, with a large proportion leaving the body as unchanged drug in the urine. Women tend to reach higher peak blood levels of both drugs compared to men after the same dose.
📦How to store it▾
Store between 20ºC to 25ºC (68 ºF to 77ºF); excursions permitted between 15ºC and 30ºC (between 59ºF and 86ºF) . Protect from light.
📄 Written from Atropine / Pralidoxime’s FDA-approved label information, summarized in plain language with AI, and reviewed by our pharmacy team before publication. Every point is grounded in that labeling — nothing is invented. How we use AI →
🩺 Pharmacist Counseling Corner
Quick, plain-English answers to the questions patients ask most about Atropine / Pralidoxime — the kind of thing our pharmacy team would talk through with you at the counter.
What exactly are DuoDote and ATNAA used for? ▾
How do I use the auto-injector, and where do I inject it? ▾
What side effects should I expect after getting this injection? ▾
Is it dangerous to use this if I'm not actually poisoned — for example, if someone gives it to me by mistake? ▾
I have a heart condition — is this safe for me? ▾
Can this be used if I'm pregnant or breastfeeding? ▾
Is Atropine / Pralidoxime available over the counter? ▾
When was Atropine / Pralidoxime first available? ▾
Who makes Atropine / Pralidoxime? ▾
💬 Answers drafted from Atropine / Pralidoxime’s FDA-approved label information, summarized in plain language with AI, and reviewed by our pharmacy team before publication. Grounded in that labeling — nothing is made up. How we use AI →
🧰 Keep exploring
📊 Atropine / Pralidoxime across the U.S. market
How Atropine / Pralidoxime appears in the FDA’s National Drug Code Directory — including its dosage forms, strengths, brand names, manufacturers, and FDA-listed product records. These are directory records, not sales or prescription volume.
Also listed with the FDA, not a patient dose form: Kit (2) — bulk drug substance sold to compounders/manufacturers and multi-item kits. These aren’t counted in the dose-form total above.
Share of FDA-listed product records by manufacturer — FDA National Drug Code Directory. Record counts are not sales or prescription volume.
🔍 Compare Atropine / Pralidoxime products
A representative set of FDA-listed product records for Atropine / Pralidoxime — across manufacturers, strengths, and dosage forms, grouped by form with each product’s manufacturer and how the FDA approved it. The same medicine may be made and packaged by different companies, so a single drug can have many directory entries. (It’s also why a refill can look different — a new shape, color, or box — even though it contains the same medication.)
| Route | Manufacturer / Labeler | Category ⓘ | Details |
|---|---|---|---|
| 💊Kits | |||
| Intramuscular | Meridian Medical Technologies, LLC | NDA | View NDC → |
| Intramuscular | Meridian Medical Technologies LLC | NDA | View NDC → |
Showing 2 of 2 products — FDA National Drug Code Directory. See every product, package size and price: browse all 2 Atropine / Pralidoxime NDCs →
📈 What people report — real-world data (FDA FAERS)
After a medicine reaches the market, patients, doctors and drugmakers can send the FDA reports of problems they think may be linked to it. Here’s what’s been reported for Atropine / Pralidoxime — a signal of what to watch for, not proof the drug caused it.
Source: openFDA, from the FDA Adverse Event Reporting System (FAERS). These are voluntary reports — they don’t prove the drug caused the effect, and counts reflect how often something was reported, not how often it actually happens. Reports also often name the very problem the medicine is taken for — a common reason to file one is that the drug didn’t help — so for a pain reliever you may see “pain” high on the list; that points to why the report was filed, not to the drug causing the symptom. This counts every report that lists Atropine / Pralidoxime in any role, so the total runs higher than the FDA’s official dashboard, which counts only cases where the drug is the suspect. For the authoritative figures, see the FDA FAERS Public Dashboard. Always talk to your pharmacist or doctor.
🏛️ The road to your pharmacy
How Atropine / Pralidoxime went from FDA review to the pharmacy shelf — the key milestones in its regulatory journey.
Source: Drugs@FDA.
🚨 Recall history
A recall is when a specific batch of a medicine is pulled from the market — usually a manufacturing issue, not a problem with the drug itself. Class I is most serious, Class III least.
Source: openFDA drug enforcement (recall) reports.
RxNorm Concept Web — From Ingredient to Every Form and Strength
This page starts with one exact multiple-ingredient concept (MIN). The branches below show its dose-form concepts (SCDF), then the available clinical drug and strength concepts (SCD). A product with a different ingredient combination belongs on a different page.
RxCUI 465370 1 dose form · 1 strength
-
Dose form (SCDF) Auto-Injector RxCUI 1659108No current FDA listingClinical drug / strength (SCD) 2.7 ML atropine 0.778 MG/ML / pralidoxime chloride 222 MG/MLRxCUI 727415
Look up RxCUI 465370 in the RxCUI Atlas →
RxNorm is the U.S. National Library of Medicine’s normalized drug vocabulary. Its concept hierarchy can include forms that are not currently marketed; the status on each branch compares that concept with current FDA listings. RxCUIs identify vocabulary concepts, not individual packages or manufacturers.
📦 Supply & shortage status
Whether Atropine / Pralidoxime is in short supply in the U.S. right now, plus any shortage history the FDA has on record. A shortage usually reflects a manufacturing or demand issue — not a safety problem with the drug.
Source: openFDA, from the FDA Drug Shortages database.
🏷️ Sold under these brand names
🏭 Manufacturers & labelers
RxNorm drug class
Atropine / Pralidoxime belongs to the Anticholinergic class.
Classified by RxNorm RxClass — the U.S. National Library of Medicine's standardized drug-classification service (Established Pharmacologic Class from the FDA, the ATC drug family from the WHO, and mechanism of action). Reference only, not medical advice.
🔬 Where this comes from
Core label, product, RxNorm, safety, and utilization data on this page come from the sources identified below. AI-written, editorial, and licensed sections are labeled separately.
How we combine label and product data
HelloPharmacist combines public FDA and NLM records; we don’t author the underlying clinical facts. We identified 2 FDA-filed SPL label sets within the page’s selected clinical scope after exact ingredient or ingredient-combination matching and applicable route/form matching. The representative label is the starting point for the displayed reference monograph; the 12 largest stored in-scope SPL records, which may include that representative, are compared section by section, and the longest available version of each section is retained. Forms, routes, brands, labelers, product-listed strengths, and product-record counts are aggregated separately from ingredient-matched FDA NDC Directory records; package records listed above are associated with the linked SPL; and the normalized concept hierarchy comes from NLM RxNorm.
For canonical ingredient pages, bounded product-attributed indication and administration excerpts may be added to the AI evidence, and the generator is instructed to preserve available product, brand, route, and form qualifiers instead of treating one label as universal. Where a section is identified as AI-written, its plain-language text is generated from bounded label evidence. New draft drug pages remain in the admin review queue before first publication. Meridian Medical Technologies LLC is the representative DailyMed label linked for verification and dates; it is not the sole source used for the page.
This is general education, not medical advice — always consult your doctor or pharmacist about your medications and any medical condition. For the exact wording of the linked representative label, view that label on DailyMed; some displayed composite sections may come from other in-scope SPL labels. Learn how we use AI and our data sources & update cadence.