Pralidoxime Is no Longer Fit for Purpose as an Antidote to Organophosphate Poisoning in the United Kingdom.

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  • Author(s): Corby G;Corby G
  • Source:
    Disaster medicine and public health preparedness [Disaster Med Public Health Prep] 2024 Feb 22; Vol. 18, pp. e32. Date of Electronic Publication: 2024 Feb 22.
  • Publication Type:
    Journal Article
  • Language:
    English
  • Additional Information
    • Source:
      Publisher: Cambridge University Press Country of Publication: United States NLM ID: 101297401 Publication Model: Electronic Cited Medium: Internet ISSN: 1938-744X (Electronic) Linking ISSN: 19357893 NLM ISO Abbreviation: Disaster Med Public Health Prep Subsets: MEDLINE
    • Publication Information:
      Publication: <2013>- : New York : Cambridge University Press
      Original Publication: Philadelphia, PA : Lippincott Williams & Wilkins
    • Subject Terms:
      Organophosphate Poisoning*/drug therapy ; Cholinesterase Reactivators*/therapeutic use ; Cholinesterase Reactivators*/pharmacology ; Pralidoxime Compounds*; Humans ; Antidotes/therapeutic use ; Acetylcholinesterase/therapeutic use
    • Abstract:
      Pralidoxime is the only oxime antidote to organophosphate poisoning stocked in the United Kingdom, produced by rational drug design in the 1950s. Typically, it is used alongside atropine, to reverse the effects of acetylcholinesterase inhibition. However, its efficacy has been questioned by recent meta-analyses of use treating attempted suicides in less economically developed countries, where organophosphate poisoning is more common. This policy analysis assesses the likely efficacy of pralidoxime in the United Kingdom, in scenarios largely different from those evaluated in meta-analyses. In all scenarios, the UK delay in antidote administration poses a major problem, as pralidoxime acts in a time-critical reactivation mechanism before "ageing" of acetylcholinesterase occurs. Additionally, changes in the organophosphates used today versus those pralidoxime was rationally designed to reverse, have reduced efficacy since the 1950s. Finally, the current dosage regimen may be insufficient. Therefore, one must re-evaluate our preparedness and approach to organophosphate poisoning in the United Kingdom.
    • Contributed Indexing:
      Keywords: cholinesterase reactivators; organophosphates; organophosphorous compounds; oximes; pralidoxime compounds
    • Accession Number:
      P7MU9UTP52 (pralidoxime)
      0 (Antidotes)
      EC 3.1.1.7 (Acetylcholinesterase)
      0 (Cholinesterase Reactivators)
      0 (Pralidoxime Compounds)
    • Publication Date:
      Date Created: 20240222 Date Completed: 20240223 Latest Revision: 20240528
    • Publication Date:
      20240528
    • Accession Number:
      10.1017/dmp.2024.25
    • Accession Number:
      38384185