ATNAA

{{Short description|Medical device}} {{Use dmy dates|date=December 2023}} {{cs1 config |name-list-style=vanc |display-authors=6}} {{Infobox drug | type = combo | image = | width = | alt = | caption =

<!-- Combo data --> | component1 = Atropine | class1 = Anticholinergic agent | component2 = Pralidoxime chloride | class2 = Antidote

<!-- Clinical data --> | pronounce = | tradename = Atnaa, Duodote | Drugs.com = {{drugs.com|ppa|atropine-and-pralidoxime}} | MedlinePlus = | licence_CA = <!-- Health Canada may use generic or brand name (generic name preferred) --> | licence_EU = <!-- EMA uses INN (or special INN_EMA) --> | DailyMedID = Atropine and pralidoxime | licence_US = <!-- FDA may use generic or brand name (generic name preferred) --> | pregnancy_AU = <!-- A / B1 / B2 / B3 / C / D / X --> | pregnancy_AU_comment = | pregnancy_category= | routes_of_administration = Intramuscular | ATCvet = | ATC_prefix = V03 | ATC_suffix = AB54 | ATC_supplemental =

<!-- Legal status --> | legal_AU = <!-- S2, S3, S4, S5, S6, S7, S8, S9 or Unscheduled --> | legal_AU_comment = | legal_BR = <!-- OTC, A1, A2, A3, B1, B2, C1, C2, C3, C4, C5, D1, D2, E, F --> | legal_BR_comment = | legal_CA = <!-- OTC, Rx-only, Schedule I, II, III, IV, V, VI, VII, VIII --> | legal_CA_comment = | legal_DE = <!-- Anlage I, II, III or Unscheduled --> | legal_DE_comment = | legal_NZ = <!-- Class A, B, C --> | legal_NZ_comment = | legal_UK = <!-- GSL, P, POM, CD, CD Lic, CD POM, CD No Reg POM, CD (Benz) POM, CD (Anab) POM or CD Inv POM / Class A, B, C --> | legal_UK_comment = | legal_US = Rx-only | legal_US_comment = <ref name="Atnaa FDA label" /><ref name="Duodote FDA label" /> | legal_UN = <!-- N I, II, III, IV / P I, II, III, IV --> | legal_UN_comment = | legal_status = <!-- For countries not listed above -->

<!-- Identifiers --> | CAS_number = | CAS_supplemental = | PubChemSubstance = 497621172 | IUPHAR_ligand = | DrugBank = | ChemSpiderID = | UNII = | KEGG = D12759 | ChEBI = | ChEMBL = | NIAID_ChemDB = | PDB_ligand = | synonyms = }}

An '''ATNAA''' ('''Antidote Treatment Nerve Agent Autoinjector''') is any of a variety of autoinjectors in use with the US Armed Forces. An autoinjector is a medical device designed to deliver a single dose of a particular (typically life-saving) drug.

Most autoinjectors are spring-loaded syringes. By design, autoinjectors are easy to use and are intended for self-administration by patients. The site of injection depends on the drug loaded, but it typically is administered into the thigh or the buttocks. The injectors were initially designed to overcome the hesitation associated with self-administration of the needle-based drug delivery device. It is the newer delivery vehicle to be used in lieu of the Mark I NAAK.

== Purpose ==

The ATNAA provides atropine and pralidoxime chloride in a single delivery system, although the two drugs are separate within the device.<ref name="Atnaa FDA label">{{cite web | title=Atnaa atropine and pralidoxime chloride auto-injector- atropine and pralidoxime chloride kit | website=DailyMed | date=22 March 2017 | url=https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=596c7a8f-27cd-4de2-9491-476f43570b8b | access-date=27 May 2020}}</ref><ref name="Duodote FDA label">{{cite web | title=Duodote- atropine and pralidoxime chloride kit | website=DailyMed | date=22 October 2018 | url=https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=241f42a0-1a33-40e8-8221-201767d999e5 | access-date=27 May 2020}}</ref> The use of the device is only to be administered in the extreme case of organophosphate poisoning. The delivery system is designed for use by military personnel only, and is only issued to DOD personnel that are considered to be in immediate danger of a chemical attack or work in a position (such as ordnance disposal) where there is a high likelihood of nerve agent exposure.<ref>{{cite web | title=Drug Approval Package: ATNAA Injection in an (Atropine/Pralidoxime) Autoinjector NDA #21-175 | website=U.S. Food and Drug Administration (FDA) | date=18 January 2006 | url=https://www.accessdata.fda.gov/drugsatfda_docs/nda/2002/21175_Atnaa.cfm | access-date=26 December 2023}}{{dead link|date=May 2025|bot=medic}}{{cbignore|bot=medic}}</ref>

== FDA approval ==

During initial trials and submission to the FDA for approval, the United States Department of Defense requested that the Food and Drug Administration (FDA) waive the requirement for the phrase 'Rx only' being included on the labeling for the ATNAA device; the rationale being that it would be confusing to troops. The waiver request was denied. The DoD opted to include the phrase at the end of the package insert instead, and this modification was found acceptable.<ref>{{cite web | page = 59 | work = Center for Drug Evaluation and Research | publisher = U.S. Food and Drug Administration | url = https://www.fda.gov/cder/foi/nda/2002/21175_Atnaa_biopharmr.pdf |title=Clinical Pharmacology and Biopharmaceutical Review |accessdate=2009-05-13 |url-status=dead |archive-url= https://web.archive.org/web/20081022205733/https://www.fda.gov/cder/foi/nda/2002/21175_Atnaa_biopharmr.pdf |archivedate=2008-10-22 }}</ref>

== Training ==

As a condition of approval, the FDA lists on the device label the precise instructions that are to be given to military personnel on dosage and administration.<ref name="Atnaa FDA label" /><ref name="Duodote FDA label" /> While each branch of the DoD typically provides their own tailored training, an example of the MK I NAAK and ATNAA are referenced in the United States Air Force Self Aid Buddy Care Training (SABC). SABC encompasses basic life support and limb-saving techniques to help wounded or injured personnel survive in medical emergencies until medical help is available.<ref>{{cite web | title = Training Objectives AFI 36-2238, SABC Training | url = http://www.e-publishing.af.mil/shared/media/epubs/AFI36-2238.pdf | archive-url = https://web.archive.org/web/20100215150212/http://www.e-publishing.af.mil/shared/media/epubs/AFI36-2238.pdf | archive-date=2010-02-15 }}</ref>

== References == {{Reflist}}

== Further reading == * {{cite journal | vauthors = Landauer W | title = Cholinomimetic teratogens. V. The effect of oximes and related cholinesterase reactivators | journal = Teratology | volume = 15 | issue = 1 | pages = 33–42 | date = February 1977 | pmid = 320703 | doi = 10.1002/tera.1420150105 }} * {{cite journal | vauthors = Moller KO, Jensen-Holm J, Lausen HH | title = HH L. Treatment of acute phosphostigmine poisoning. | journal = Ugeskrift for Laeger | date = April 1961 | volume = 123 | pages = 501–5 | pmid = 13771863 }} * {{cite journal | vauthors = Namba T, Nolte CT, Jackrel J, Grob D | title = Poisoning due to organophosphate insecticides. Acute and chronic manifestations | journal = The American Journal of Medicine | volume = 50 | issue = 4 | pages = 475–92 | date = April 1971 | pmid = 4324629 | doi = 10.1016/0002-9343(71)90337-8 }} * {{cite book | vauthors = Arena JM | title = Poisoning. Toxicology, symptoms, treatments. | edition = 4th | location = Springfield, IL | publisher = Charles C. Thomas. | date = 1974 | page = 133 }} * {{cite journal | vauthors = Brachfeld J, Zavon MR | title = Organic phosphate (phosdrin) intoxication. Report of a case and the results of treatment with 2-PAM | journal = Archives of Environmental Health | volume = 11 | issue = 6 | pages = 859–62 | date = December 1965 | pmid = 5846083 | doi = 10.1080/00039896.1965.10664314 }} * {{cite book | vauthors = Hayes Jr WJ | title = Toxicology of Pesticides | location = Baltimore | publisher = The Williams & Wilkins Company | date = 1975 | page = 416 }}

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Category:Combination drugs Category:Medical equipment Category:Military equipment of the United States