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As a result of the suppressed levels of catalase, there is an increased concentration of hydrogen peroxide, which can be further decomposed to hydroxyl radicals by a photochemical reaction (Schallreuter et al
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
Pharmacological effects of meldonium: biochemical mechanisms and biomarkers of cardiometabolic activity
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