• Poisoning/overdose

Duodote Generic Name & Formulations

General Description

Atropine 2.1mg/0.7mL, pralidoxime chloride 600mg/2mL; soln for IM inj.

Pharmacological Class

Cholinergic muscarinic antagonist + cholinesterase reactivator.

How Supplied

Single-dose autoinjector—1


Generic Availability


Mechanism of Action

Atropine competitively blocks the effects of acetylcholine, including excess acetylcholine due to organophosphorus poisoning, at muscarinic cholinergic receptors on smooth muscle, cardiac muscle, secretory gland cells, and in peripheral autonomic ganglia and the central nervous system.

Pralidoxime reactivates acetylcholinesterase which has been inactivated by phosphorylation due to an organophosphorus nerve agent or insecticide. Reactivated acetylcholinesterase hydrolyzes excess acetylcholine resulting from organophosphorus poisoning to help restore impaired cholinergic neural function. 

Duodote Indications


Treatment of poisoning by organophosphorus nerve agents and organophosphorus insecticides in patients weighing >41kg.

Duodote Dosage and Administration

Adults and Children

≤41kg: not established. See full labeling. Wait 10–15mins to take effect. Closely monitor patients for ≥48–72hrs. >41kg: Mild symptoms: give 1 single-dose IM inj into mid-lateral thigh if ≥2 mild symptoms present; if after the 1st dose and any severe symptoms develop, give 2 additional single-dose IM inj in rapid succession. Severe symptoms: give 3 single-dose IM inj in mid-lateral thigh in rapid succession if any severe symptoms present.

Duodote Contraindications

Not Applicable

Duodote Boxed Warnings

Not Applicable

Duodote Warnings/Precautions


Should be administered by healthcare providers experienced in treatment of nerve agent or insecticide intoxication. Recent MI and/or severe coronary artery disease. Known cardiovascular disease or cardiac conduction disorders. Avoid excessive exercise and heat exposure. Acute glaucoma. Urinary retention. Significant bladder outflow obstruction. Pyloric stenosis. Exacerbation of chronic lung disase; monitor respiratory status. Severe renal or hepatic impairment: may require less frequent doses after initial dose. Elderly. Pregnancy. Nursing mothers.

Duodote Pharmacokinetics


Plasma protein bound: 14–22% (atropine).


Renal. Half-life: 2.4±0.3 hours (atropine), 2±1 hours (pralidoxime). 

Duodote Interactions


May accelerate reversal of neuromuscular blockers (eg, succinylcholine, mivacurium); monitor. 

Duodote Adverse Reactions

Adverse Reactions

Blurred vision, photophobia, confusion, palpitations, flushing, constipation, vision changes, dizziness, headache, drowsiness, nausea, tachycardia, increased BP, muscular weakness, dry mouth, emesis, rash, dry skin, hyperventilation, decreased renal function, excitement, manic behavior, transient elevation of liver enzymes, creatine phosphokinase.

Duodote Clinical Trials

See Literature

Duodote Note

Not Applicable

Duodote Patient Counseling

See Literature