Skip to main content
Log in

Blood levels, urinary excretion and potential toxicity of N, N′-trimethylenebis (pyridinium 4-aldoxime) dichloride (TMB-4) in healthy man following intramuscular injection of the oxime

  • Originals
  • Published:
Pharmacologia Clinica Aims and scope Submit manuscript

Summary

A dose of 250 mg (2.5–3.5 mg/kg body weight) of TMB-4 was given by i.m. injection to 12 healthy male subjects. The concentration of oxime in blood reached 2 μ/ml blood in 5 min and was sustained above this level for the subsequent 2.5 h. Within the first 4 h after its administration, 46% of the oxime was excreted in the urine. Observations on subjective manifestations following administration of the oxime and its effect on the cardiovascular and respiratory system indicate that TMB-4, in the dose range studied, is as well tolerated as other oximes in doses which would be expected to have a comparable antidotal action in dialkylphosphate poisoning. The results are discussed in relation to published information on other oximes.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  • Barkman, R., Edgren, B., Sundwall, A.: Self-administration of pralidoxime in nerve gas poisoning with a note on the stability of the drug. J. Pharm. (Lond.) 15, 671–677 (1963).

    Google Scholar 

  • Calesnic, B., Christensen, J. A., Richter, M.: Human toxicity of various oximes. Arch. Environ. Health. 15, 599–608 (1967).

    Google Scholar 

  • — Di Palma, Christensen, J. A.:Presser effects produced in man by parenteral administration of oxime. Toxicol. and Applied Pharmacol. 3, 341–342 (1964) (Abstract 6).

    Google Scholar 

  • Creasey, H. N., Green, A. L.: 2-Hydroxyiminomethyl-N-methylpyridinium methanesulphonate (P2S), an antidote to organophosphorous poisoning. Its preparation, estimation and stability. J. Pharm. (Lond.) 8, 485–490 (1959).

    Google Scholar 

  • Erdmann, W.D.: Klinische Erfahrungen mit dem Antidot Pyridine-2-Aldoxime-Methyljodid (PAM) bei E-605-Vergiftungen. Ausgewählte Kasuistik. Dtsch. med. Wschr. 85, 1014–1016 (1960).

    Google Scholar 

  • —, Bosse, I., Franke, P.: Absorption and excretion of toxogonin, an alkyl-phosphate antidote, after intramuscular injection in man. Germ. med. Monthly 12, 503–505 (1965).

    Google Scholar 

  • — Engelhard, H.: Pharmakologisch-toxikologische Untersuchungen mit deco Dichlorid des Bis (4-hydroxyiminomethyl-pyridinium-(1)-methyl)-Äthers, einem neuen Esterase-Reactivator. Arzneimittel-Forsch. 14, 5–13 (1964).

    Google Scholar 

  • —, Sakai, F., Scheler, F.: Erfahrungen bei der spezifischen Behandlung einer E-605-Vergiftung mit Atropin und dem Esteraseaktivator PAM. Dtsch. med. Wschr. 83, 1359–1362 (1958).

    Google Scholar 

  • Fleisher, J. H., Hansa, J., Killos, P. J., Harrison, C. S.: Effects of 1,1′-trimethylenebis (4-formylpyridinium bromide) dioxime (TMB-4) on cholinesterase activity and neuromuscular block following poisoning with sarin and DFP. J. Pharmacol. exp. Ther. 130, 461–468 (1960).

    Google Scholar 

  • —, Michel, H. O., Yates, L., Harrison, C. S.: 1,1′-Trimethylenebis (4-formylpyridinium bromide) dioxime (TMB-4) and 2-pyridine aldoxime methiodide (2-PAM) as adjuvans to atropine in the treatment of anticholinesterase poisoning. J. Pharmacol. exp. Ther. 129, 31–35 (1960).

    Google Scholar 

  • —, Moen, T. H., Ellingson, N. R.: Effects of 2-PAM and TMB-4 on neuromuscular transmission. J. Pharmacol. exp. Ther. 149, 311–319 (1965).

    Google Scholar 

  • Funckes, A. J.: Treatment of severe parathion poisoning with 2-pyridine aldoxime methiodide (2-PAM). Arch. Environ. Health 1, 404–406 (1960).

    Google Scholar 

  • Golikov, S. N., Rozengart, V. I.: In Holinesterazi i antiholinesteraznie vešćestva. Leningrad: Izdateljstvo „Medicina” 1964.

    Google Scholar 

  • Grob, D.: Anticholinesterase intoxication in man and its treatment. In: Handbuch der Experimentellen Pharmakologie 15, 989–1027, sub-ed. Koelle, G.B. Berlin-Göttingen-Heidelberg: Springer-Verlag 1963.

    Google Scholar 

  • —, Johns, R. J.: Treatment of anticholinesterase intoxication with oximes. J. Amer. med. Ass. 166, 1855–1858 (1958).

    Google Scholar 

  • — — Use of oximes in the treatment of intoxication by anticholinesterase compounds in normal subjects Amer. J. Med. 24, 497–511 (1958).

    Google Scholar 

  • Heilbronn, E., Tolagen, B.: Toxogonin in sarin, soman and tabun poisoning. Bioch. Pharmacol. 14, 73–77 (1965).

    Google Scholar 

  • Hobbiger, F.: Reactivation of phosphorylated acetylcholinesterase. In: Handbuch der Experimentellen Pharmakologie 15, 921–988, sub-ed. Koelle, G.B. Berlin-Göttingen-Heidelberg: Springer-Verlag 1963.

    Google Scholar 

  • — O'Sullivan, D. G., Sadler, P. W.: New potent reaetivators of acetocholinesterase inhibited by tetraethyl pyrophosphate. Nature (Lond.) 182,1498–1499 (1958).

    Google Scholar 

  • — Pitmann, M., Sadler, P. W.: Reactivation of phosphorylated acetocholinesterases by pyridinium aldoximes and related compounds. Biochem. J. 75, 363–372 (1960).

    Google Scholar 

  • — Sadler, P. W.: Protection by oximes of bispyridinium ions against lethal diisopropyl phosphonofluoridate poisoning. Nature (Lond.) 182, 1672–1673 (1958).

    Google Scholar 

  • — Vojvodić, V.: The reactivating and antidotal action of N,N′-trimethylenebis (pyridinium-4-aldoxime) (TMB-4) anf N,N′-oxydimethylenebis (pyridinium-4-aldoxime) (Toxogonin) with particular reference to their effect on phosphorylated acetylcholinesterase in the brain. Bioch. Pharmacol. 15, 1677–1690 (1966).

    Google Scholar 

  • — — The reactivation by pyridinium aldoximes of phosphorylated acetylcholinesterase in the central nervous system. Bioch. Pharmacol. 16, 455–462 (1967).

    Google Scholar 

  • Imo, K.: Behandlung einer E-605-Vergiftung mit Atropin und PAM. Medizinische 44, 2114–2115 (1959).

    Google Scholar 

  • Jager, B.V., Stagg, G.N.: Toxicity of diacetyl monoxime and pyridine-2-aldoxime methiodide in man. Johns. Hopk. Hosp. 102, 203–211 (1958).

    Google Scholar 

  • — Green, N., Jager, L.: Studies on distribution and disappearance of pyridine-2-aldoxime methiodide (PAM) and of diacetyl monoxime (DAM) in man and in experimental animals. Johns. Hopk. Hosp. 102, 225–234 (1958).

    Google Scholar 

  • Lindgren, P., Sundwall, A.: Parasympatholytic effects of TMB-4 (1,1′-trimethylenebis (4-formylpyridinium bromide) -dioxime) and some related oximes in the cat. Acta pharmacol. (Kbh.) 17, 69–83 (1960).

    Google Scholar 

  • Maksimović, M., Vojvodić, V.: Izbor metode za merenje sadržaja oksima u biološkom materijalu. Arh. Hig. Rada 20, 173–176 (1969).

    Google Scholar 

  • Milošević, M., Vojvodiö, V.: Neka farmakološka dejstva piridin-2-aldoksima-metjodida (PAM-2) i N,N′-trime-tilenbis (4-hidroksiminometilpiridinium-bromida) (TMB-4). Vojno-sanit. Pregl. 2, 164–167 (1960).

    Google Scholar 

  • —, — Milošević, V.: Zaštitno dejstvo reaktivatora holinesteraza kod Evotinja otrovanih organofosfornim insekticidima. Vojno-sanit. Pregl. 5, 525–528 (1960).

    Google Scholar 

  • —, — Terzić, M.: Blood concentration of N,N′-trimethylenebis (pyridinium-4-aldoxime) (TMB-4) and N,N′-oxydimethylenebis (pyridinium-4-aldoxime) (toxogonin) after intravenous and intramuscular administration in the dog. Bioch. Pharmacol. 16, 2435–2438 (1967).

    Google Scholar 

  • Namba, T., Hiraki, K.: PAM (pyridine-2-aldoxime methiodide) therapy for alkylphosphate poisoning. J. Amer. med. Ass. 166, 1834–1839 (1958).

    Google Scholar 

  • Oberst, F. W., Crook, J. W., Keen, W. S.: The effectiveness of 2-PAM and TMB-4 as adjuncts to atropine therapy in dogs exposed to sarin vapor by inhalation. J. Pharmacol. exp. Ther. 136, 393–396 (1962).

    Google Scholar 

  • Spiegelberg, U., Krause, W.F.J.: Zer Therapie der akuten E-605-Vergiftung: Nervenarzt 31, 36–38 (1960).

    Google Scholar 

  • Stahler, O.: On the clinical aspects and therapy of E-605-poisoning. Münchn. med. Wschr. 103, 1148–1150 (1961).

    Google Scholar 

  • Sundwall, A.: Minimum concentrations of N-methylpyridinium-2-aldoxime methane sulphonate which reverse neuromuscular block. Bioch. Pharmacol. 8, 413–417 (1961).

    Google Scholar 

  • — Pharmacological studies of cholinesterase reactivating oximes. T. milit. Hälsov. 87, 3–31 (1962).

    Google Scholar 

  • — Plasma concentration curves of N-methylpyridinium-2-aldoxime methane sulphonate (P2S) after intravenous, intramuscular and oral administration in man. Bioch. Pharmacol. 5, 225–230 (1960).

    Google Scholar 

  • Vojvodić, V., Grbeša, B.: Farmakodinamski učinci oksima (LüH6) na zdravim Ijudima — dobrovoljcima. In: Odabrana poglavlja iz Toksikologije. I Jugoslovenski simpozijum o medicinskoj toksikologiji, 294–298. Beograd: 1968.

  • —, — Upotreba piridin-2-aldoksima-metjodida (PAM-2) u terapiji intoksikacije arminom u čoveka. Vojno-sanit. Pregl. 12, 1138–1141 (1961).

    Google Scholar 

  • —, Vojvodić, M.: Protektivno delovanje oksima i atropina pri trovanju arminom. Arh. Hig. Rada 18, 131–137 (1967).

    Google Scholar 

  • —, Wiezorek, W. D., Matzkowski, H., Schnitziein, W.: Untersuchungen über die Wirkung von 1,1′-Trime-thylen-bis-(4-hydroximino-formyl-pyridinium)-dibromid (TMB-4) auf Kreislauffunktionen des Menschen. Bioch. Pharmacol. Supplement to vol. 12, 217 (1963).

    Google Scholar 

  • Wills, J.H.: Recent studies of organic phosphate poisoning. Fed. Proc. 18, 1020–1025 (1959).

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

About this article

Cite this article

Vojvodić, V.B. Blood levels, urinary excretion and potential toxicity of N, N′-trimethylenebis (pyridinium 4-aldoxime) dichloride (TMB-4) in healthy man following intramuscular injection of the oxime. Pharmacol. Clin. 2, 216–220 (1970). https://doi.org/10.1007/BF00404303

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF00404303

Keywords

Navigation