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2017 Jun 1;312(6):G55971

Rybelsus Tablets: Initial dose (initiation phase

Note that 2-PAM has an affinity for the acetylcholine anionic binding site on cholinesterase (right middle panel), which could explain the oxime related worsening of cholinergic side effects when 2-PAM is administered prior to the onset of action of atropine in the setting of organophosphate poisoning, by transiently preventing nerve-agent free cholinesterase from interacting with acetylcholine