Why Pralidoxime is CONTRAINDICATED in Carbamate Poisoning?

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Video Summary:
For pralidoxime to work the anionic site of the enzyme must be free. In organophosphate poisoning, it is free. So pralidoxime can bind to this site, and then take away the organophosphate molecule. So the benefit of reactivation of enzyme is present in organophosphate poisoning. But in the case of carbamate poisoning, the anionic site is occupied. And pralidoxime cannot work on such enzymes. So there is no reactivation of the carbamylated enzyme. Small loss due to weak anticholinesterase activity is present in both cases. The final answer is, pralidoxime is indicated in organophosphate poisoning because the benefit is much more than the loss. But it's contraindicated in carbamate poisoning because there is no benefit in form of reactivation of enzyme. There's only loss.
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