ATNAA atropine and pralidoxime chloride

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Overview

What is ATNAA atropine and pralidoxime chloride?

The Antidote Treatment - Nerve Agent, Auto-Injector (ATNAA) provides Atropine Injection and Pralidoxime Chloride Injection in separate chambers as sterile, pyrogen-free solutions for intramuscular injection.

The ATNAA is a specially designed unit for automatic self- or buddy-administration by military personnel. When activated, the ATNAA sequentially administers atropine and pralidoxime chloride through a single needle. The recommended procedure (see ) is to inject the contents of the auto-injector into the muscles of an outer thigh or into the buttocks.

When activated, each ATNAA dispenses:

2.1 mg atropine in 0.7 mL of a sterile, pyrogen-free solution containing 12.47 mg glycerin and not more than 2.8 mg phenol, citrate buffer, and Water for Injection. The pH range is 4.0 – 5.0.

And

600 mg of pralidoxime chloride in 2 mL of a sterile, pyrogen-free solution containing 40 mg benzyl alcohol, 22.5 mg glycine, and Water for Injection. The pH is adjusted with hydrochloric acid. The pH range is 2.0 – 3.0.

After an ATNAA has been activated, the empty container should be disposed of properly (see

DOSAGE AND ADMINISTRATION

Atropine, an anticholinergic agent (muscarinic antagonist), occurs as white crystals, usually needle- like, or as a white, crystalline powder. It is slightly soluble in water, soluble in glycerin and ether, and freely soluble in alcohol and chloroform with a molecular weight of 289.38. Atropine, a naturally occurring belladonna alkaloid, is a racemic mixture of equal parts of d- and l- hyoscyamine, whose activity is due almost entirely to the levo isomer of the drug. Chemically, atropine is designated as 1αH,5αH-Tropan-3α-ol (±)-tropate. Its empirical formula is CHNO and its structural formula is:

Pralidoxime chloride, a cholinesterase reactivator, is an odorless, white to pale-yellow crystalline powder, freely soluble in water, with a molecular weight of 172.61. Chemically, pralidoxime chloride is designated as 2-formyl-1-methylpyridinium chloride oxime. Its empirical formula is CHCINO and its structural formula is:

The specific activity of the drug resides in the 2-formyl-1-methylpyridinium ion and is independent of the particular salt employed. The chloride salt is preferred because of physiologic compatibility, excellent water solubility at all temperatures, and high potency per gram, due to its low molecular weight.

What does ATNAA atropine and pralidoxime chloride look like?

What are the available doses of ATNAA atropine and pralidoxime chloride?

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What should I talk to my health care provider before I take ATNAA atropine and pralidoxime chloride?

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How should I use ATNAA atropine and pralidoxime chloride?

The ATNAA is indicated for the treatment of poisoning by susceptible organophosphorous nerve agents having anticholinesterase activity.

For optimal reactivation of organophosphorous-inhibited cholinesterase, the ATNAA should be administered as soon as possible after appearance of symptoms of nerve agent poisoning (see below).

The ATNAA should be self- or buddy–administered by military personnel after donning protective mask and hood at the first sign of a chemical attack, and only if some or all of the following mild symptoms of nerve agent exposure are present:

The following are the instructions that should be given to military personnel.

What interacts with ATNAA atropine and pralidoxime chloride?

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What are the warnings of ATNAA atropine and pralidoxime chloride?

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What are the precautions of ATNAA atropine and pralidoxime chloride?

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What are the side effects of ATNAA atropine and pralidoxime chloride?

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What should I look out for while using ATNAA atropine and pralidoxime chloride?

In the face of life-threatening poisoning by organophosphorous nerve agents, there are no absolute contraindications for the use of the ATNAA (see ).

While ATNAA can be administered to all individuals with a life-threatening exposure to organophosphorous nerve agents, it should be administered with extreme caution to individuals with the following disorders when the symptoms of nerve agent poisoning are less severe: individuals who are hypersensitive to any component of the product, disorders of heart rhythm such as atrial flutter, severe narrow angle glaucoma, pyloric stenosis, or prostatic hypertrophy.

More than one dose of ATNAA, to a maximum of three doses, may be necessary, especially when exposure is massive or symptoms are severe (see ). Children are more susceptible than adults to the toxic effects of anticholinergic agents.

Severe difficulty in breathing requires artificial respiration in addition to the use of the ATNAA.

Pralidoxime is not effective in the treatment of poisoning due to phosphorus, inorganic phosphates, or organophosphates not having anticholinesterase activity.

What might happen if I take too much ATNAA atropine and pralidoxime chloride?

How should I store and handle ATNAA atropine and pralidoxime chloride?

Store at The Antidote Treatment – Nerve Agent, Auto-Injector (ATNAA) provides Atropine Injection (atropine, 2.1 mg/0.7 mL) and Pralidoxime Chloride Injection (pralidoxime chloride, 600 mg/2 mL) in sterile solutions for intramuscular injection. The ATNAA is a self-contained unit designed for automatic self- or buddy-administration by military personnel. ATNAAs are supplied through the Directorate of Medical Materiel, Defense Supply Center, Philadelphia. Store at 25°C (77°F); excursions permitted to 15 - 30°C (59 - 86°F)[see USP Controlled Room Temperature] Keep from Freezing. Protect from Light.Manufactured by: MERIDIAN MEDICAL TECHNOLOGIES, INC.A wholly-owned subsidiary of King Pharmaceuticals, Inc. 00015664/10 Rx only. The Antidote Treatment – Nerve Agent, Auto-Injector (ATNAA) provides Atropine Injection (atropine, 2.1 mg/0.7 mL) and Pralidoxime Chloride Injection (pralidoxime chloride, 600 mg/2 mL) in sterile solutions for intramuscular injection. The ATNAA is a self-contained unit designed for automatic self- or buddy-administration by military personnel. ATNAAs are supplied through the Directorate of Medical Materiel, Defense Supply Center, Philadelphia. Store at 25°C (77°F); excursions permitted to 15 - 30°C (59 - 86°F)[see USP Controlled Room Temperature] Keep from Freezing. Protect from Light.Manufactured by: MERIDIAN MEDICAL TECHNOLOGIES, INC.A wholly-owned subsidiary of King Pharmaceuticals, Inc. 00015664/10 Rx only. The Antidote Treatment – Nerve Agent, Auto-Injector (ATNAA) provides Atropine Injection (atropine, 2.1 mg/0.7 mL) and Pralidoxime Chloride Injection (pralidoxime chloride, 600 mg/2 mL) in sterile solutions for intramuscular injection. The ATNAA is a self-contained unit designed for automatic self- or buddy-administration by military personnel. ATNAAs are supplied through the Directorate of Medical Materiel, Defense Supply Center, Philadelphia. Store at 25°C (77°F); excursions permitted to 15 - 30°C (59 - 86°F)[see USP Controlled Room Temperature] Keep from Freezing. Protect from Light.Manufactured by: MERIDIAN MEDICAL TECHNOLOGIES, INC.A wholly-owned subsidiary of King Pharmaceuticals, Inc. 00015664/10 Rx only. The Antidote Treatment – Nerve Agent, Auto-Injector (ATNAA) provides Atropine Injection (atropine, 2.1 mg/0.7 mL) and Pralidoxime Chloride Injection (pralidoxime chloride, 600 mg/2 mL) in sterile solutions for intramuscular injection. The ATNAA is a self-contained unit designed for automatic self- or buddy-administration by military personnel. ATNAAs are supplied through the Directorate of Medical Materiel, Defense Supply Center, Philadelphia. Store at 25°C (77°F); excursions permitted to 15 - 30°C (59 - 86°F)[see USP Controlled Room Temperature] Keep from Freezing. Protect from Light.Manufactured by: MERIDIAN MEDICAL TECHNOLOGIES, INC.A wholly-owned subsidiary of King Pharmaceuticals, Inc. 00015664/10 Rx only. The Antidote Treatment – Nerve Agent, Auto-Injector (ATNAA) provides Atropine Injection (atropine, 2.1 mg/0.7 mL) and Pralidoxime Chloride Injection (pralidoxime chloride, 600 mg/2 mL) in sterile solutions for intramuscular injection. The ATNAA is a self-contained unit designed for automatic self- or buddy-administration by military personnel. ATNAAs are supplied through the Directorate of Medical Materiel, Defense Supply Center, Philadelphia. Store at 25°C (77°F); excursions permitted to 15 - 30°C (59 - 86°F)[see USP Controlled Room Temperature] Keep from Freezing. Protect from Light.Manufactured by: MERIDIAN MEDICAL TECHNOLOGIES, INC.A wholly-owned subsidiary of King Pharmaceuticals, Inc. 00015664/10 Rx only. The Antidote Treatment – Nerve Agent, Auto-Injector (ATNAA) provides Atropine Injection (atropine, 2.1 mg/0.7 mL) and Pralidoxime Chloride Injection (pralidoxime chloride, 600 mg/2 mL) in sterile solutions for intramuscular injection. The ATNAA is a self-contained unit designed for automatic self- or buddy-administration by military personnel. ATNAAs are supplied through the Directorate of Medical Materiel, Defense Supply Center, Philadelphia. Store at 25°C (77°F); excursions permitted to 15 - 30°C (59 - 86°F)[see USP Controlled Room Temperature] Keep from Freezing. Protect from Light.Manufactured by: MERIDIAN MEDICAL TECHNOLOGIES, INC.A wholly-owned subsidiary of King Pharmaceuticals, Inc. 00015664/10 Rx only. The Antidote Treatment – Nerve Agent, Auto-Injector (ATNAA) provides Atropine Injection (atropine, 2.1 mg/0.7 mL) and Pralidoxime Chloride Injection (pralidoxime chloride, 600 mg/2 mL) in sterile solutions for intramuscular injection. The ATNAA is a self-contained unit designed for automatic self- or buddy-administration by military personnel. ATNAAs are supplied through the Directorate of Medical Materiel, Defense Supply Center, Philadelphia. Store at 25°C (77°F); excursions permitted to 15 - 30°C (59 - 86°F)[see USP Controlled Room Temperature] Keep from Freezing. Protect from Light.Manufactured by: MERIDIAN MEDICAL TECHNOLOGIES, INC.A wholly-owned subsidiary of King Pharmaceuticals, Inc. 00015664/10 Rx only. The Antidote Treatment – Nerve Agent, Auto-Injector (ATNAA) provides Atropine Injection (atropine, 2.1 mg/0.7 mL) and Pralidoxime Chloride Injection (pralidoxime chloride, 600 mg/2 mL) in sterile solutions for intramuscular injection. The ATNAA is a self-contained unit designed for automatic self- or buddy-administration by military personnel. ATNAAs are supplied through the Directorate of Medical Materiel, Defense Supply Center, Philadelphia. Store at 25°C (77°F); excursions permitted to 15 - 30°C (59 - 86°F)[see USP Controlled Room Temperature] Keep from Freezing. Protect from Light.Manufactured by: MERIDIAN MEDICAL TECHNOLOGIES, INC.A wholly-owned subsidiary of King Pharmaceuticals, Inc. 00015664/10 Rx only.

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Clinical Information

Chemical Structure

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Clinical Pharmacology

Non-Clinical Toxicology

In the face of life-threatening poisoning by organophosphorous nerve agents, there are no absolute contraindications for the use of the ATNAA (see ).

While ATNAA can be administered to all individuals with a life-threatening exposure to organophosphorous nerve agents, it should be administered with extreme caution to individuals with the following disorders when the symptoms of nerve agent poisoning are less severe: individuals who are hypersensitive to any component of the product, disorders of heart rhythm such as atrial flutter, severe narrow angle glaucoma, pyloric stenosis, or prostatic hypertrophy.

More than one dose of ATNAA, to a maximum of three doses, may be necessary, especially when exposure is massive or symptoms are severe (see ). Children are more susceptible than adults to the toxic effects of anticholinergic agents.

Severe difficulty in breathing requires artificial respiration in addition to the use of the ATNAA.

Pralidoxime is not effective in the treatment of poisoning due to phosphorus, inorganic phosphates, or organophosphates not having anticholinesterase activity.

Drug Interactions:

The following precautions should be kept in mind in the treatment of anticholinesterase poisoning, although they do not bear directly on the use of atropine and 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 treating personnel with organophosphorous poisoning.

General:

Because pralidoxime is excreted in the urine, a decrease in renal function will result in increased blood levels of the drug.

The ATNAA should be used with caution in all individuals over 40 years of age. Conventional systemic doses may precipitate acute glaucoma in susceptible patients, convert partial organic pyloric stenosis into complete pyloric obstruction, precipitate urinary retention in patients with prostatic hypertrophy, or cause inspiration of bronchial secretions and formation of dangerous viscid plugs in patients with chronic lung disease.

Mild to moderate pain may be experienced at the site of injection.

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Reference

This information is obtained from the National Institute of Health's Standard Packaging Label drug database.
"https://dailymed.nlm.nih.gov/dailymed/"

While we update our database periodically, we cannot guarantee it is always updated to the latest version.

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