The inadequacy of postexposure therapy for nerve agent casualties, particularly those with potentially lethal exposures to soman, has been of great concern. Development of pyridostigmine, a peripherally active carbamate compound, as a nerve agent pretreatment adjunct has substantially improved the ability of the U.S. military to protect its soldiers from the lethal effects of nerve agents. A major deficiency of this pretreatment program --that it does not protect the CNS against nerve agent-induced injury--may be overcome by postexposure administration of anticonvulsants. While centrally acting pretreatments offer more effective protection than does pyridostigmine, their development is limited because of their potential for impairing soldier performance. New research may provide a revolutionary advance in protection against nerve agents with biotechnologically derived pretreatments that bind or inactivate nerve agents in the circulation.
Textbook of Military Medicine: Medical Aspects of Chemical and Biological Warfare, p. 181-196