Atropine Absorption after Intramuscular Administration with 2-Pralidoxime Chloride by Two Automatic Injector Devices

Characterization of early plasma concentrations of midazolam in pigs after administration by an autoinjector

“…The use of an autoinjector containing midazolam increased significantly the plasma levels obtained during the first 15 min following administration and thus might contribute to its efficacy as well. This increase, similar to that found for other drugs in the past [12][13][14], is probably attributed to the larger area spread of the drug following autoinjector administration, which facilitates faster absorption. In a human study of 15 subjects with various midazolam doses, it has been found that the C max of the drug was proportional to the administered dose, and the degree of sedation was significantly correlated to the midazolam plasma levels [18].…”

“…[13]. In another study, the performance of an atropine autoinjector (Mark I, used in the US Army) was tested in 20 human volunteers against a different injector referred to as an MCP [14]. The Mark I injector exhibited a significantly higher atropine concentration in plasma 10 min after injection.…”

The use of atropine in a nerve agent response with specific reference to children: are current guidelines too cautious?

“…Consequently, the intramuscular route has been favoured traditionally, primarily as a result of the ease of rapid self-administration in the battlefield 33. Whereas there is evidence to support the use of autoinjectors over a needle and syringe,18 there is no scope for self-administration of an antidote in the civilian setting. Further consideration of subcutaneous atropine as a faster alternative to the intramuscular route is required.…”

“…Military autoinjector Mark 1 kits, containing 2 mg atropine and 600 mg pralidoxime, are therefore frequently advised for use in civilian adults exposed to nerve agents. The use of an autoinjector device is believed to result in broader drug dispersion and increased rate of absorption than would be achieved with a needle and syringe 18. A specific paediatric autoinjector device has recently been introduced, which, in contrast to the adult device, contains only atropine and no pralidoxime 15 19 20.…”

Organophosphate Antidote Auto-Injectors vs. Traditional Administration: A Time Motion Study

“…The advantages of autoinjectors have been explored and documented and include these requirements: less training and skill to administer; they allow pre-hospital providers and even non-medical personnel to quickly learn the use of the devices; they allow providers to quickly use the device instead of drawing up multiple doses of antidotes from vials; and the dispersion of antidotes when given via auto-injectors allows for more rapid absorption (5)(6)(7). When the antidote is delivered through auto-injectors, it reaches general circulation twice as rapidly as traditional needle/syringe delivery (8).…”