Prophylaxis AChE protected against inhibition

A third approach to protection against excessive AChE inhibition lies in pretreatment with reversible inhibitors of the enzyme to prevent binding of the irreversible organophosphate inhibitor. This prophylaxis can be achieved with pyridostigmine or physostigmine but is reserved for situations in which possibly lethal poisoning is anticipated, eg, chemical warfare. Simultaneous use of atropine is required to control muscarinic excess. 

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