Neostigmine

Indications
Oral
Myasthenia gravis
Adult: As bromide: 15 mg every 3-4 hr. Total daily dose is 75-300 mg in divided doses. Individualise dosing intervals to maximal response.
Child: As bromide: 2 mg/kg daily, divided into doses and given every 3-4 hr. Total daily dose is 15-90 mg.
CrCl (ml/min)Dosage Recommendation
10-5050% of normal dose.
<1025% of normal dose.

Oral
Paralytic ileus and postoperative urinary retention
Adult: As bromide: 15-30 mg.
CrCl (ml/min)Dosage Recommendation
10-5050% of normal dose.
<1025% of normal dose.

Oral
Neonatal myasthenia gravis
Child: As bromide: 1-5 mg every 4 hr.
CrCl (ml/min)Dosage Recommendation
10-5050% of normal dose.
<1025% of normal dose.

Parenteral
Myasthenia gravis
Adult: As metilsulfate: 0.5-2.5 mg IM/SC at intervals, up to a total daily dose of 5-20 mg.
Child: As metilsulfate: 200-500 mcg IM/SC as single daily dose.
CrCl (ml/min)Dosage Recommendation
10-5050% of normal dose.
<1025% of normal dose.

Parenteral
Paralytic ileus and postoperative urinary retention
Adult: As metilsulfate: 0.5 mg IM/SC.
CrCl (ml/min)Dosage Recommendation
10-5050% of normal dose.
<1025% of normal dose.

Intravenous
Reversal of neuromuscular blockade
Adult: As metilsulfate: 50-70 mcg/kg by IV inj over 60 sec. Alternatively, 0.5-2 mg up to a max of 5 mg.
Child: As metilsulfate: Children: 0.025-0.08 mg/kg/dose. Infants: 0.025-0.1 mg/kg/dose.
CrCl (ml/min)Dosage Recommendation
10-5050% of normal dose.
<1025% of normal dose.

Parenteral
Neonatal myasthenia gravis
Child: As metilsulfate: 50-250 mcg IM/SC every 4 hr.
CrCl (ml/min)Dosage Recommendation
10-5050% of normal dose.
<1025% of normal dose.

Intramuscular
Diagnosis of myasthenia gravis
Adult: As metilsulfate: 0.02 mg/kg as a single dose. Discontinue all anticholinesterase medications for at least 8 hr prior to admin.
Child: As metilsulfate: 0.04 mg/kg as a single dose. Discontinue all anticholinesterase medications for at least 8 hr prior to admin.
Ophthalmic
Glaucoma
Adult: Instil 1-2 drops of 0.5% solution into the eyes 1-4 times daily.
Contraindications
Mechanical GI or urinary tract obstruction, peritonitis.
Warnings / Precautions
Patients with epilepsy, bronchial asthma, bradycardia, recent MI, hypotension, vagotonia, hyperthyroidism, recent intestinal or bladder surgery, renal impairment, arrhythmias, peptic ulcer. Distinguish cholinergic crisis due to overdosage from myasthenic crisis. Pregnancy and lactation. Atropine should always be available when given by inj.
Adverse Reactions
Increased salivation and sweating, nausea and vomiting, abdominal cramps, diarrhoea, allergic reactions, rash (bromide salt), miosis, increased bronchial secretions, bradycardia, bronchospasm, weakness, muscle cramps, fasciculation, hypotension.
Potentially Fatal: Anaphylaxis.
Overdose Reactions
Symptoms: Muscle weakness, blurred vision, excessive sweating, tearing and salivation, nausea, vomiting, diarrhoea, hypertension, bradycardia, muscle weakness, paralysis. Management: Atropine sulfate inj should be readily available.
Drug Interactions
May reduce effects of anticholinergics. May increase effects of cholinergic agonists. Increased risk of bradycardia with digoxin, diltiazem, verapamil or β-blockers without intrinsic sympathomimetic activity. Increased muscle weakness and decreased response to anticholinesterases with corticosteroids. May increase effects of depolarising neuromuscular blockers. Effects may be antagonised by drugs with neuromuscular blocking activity e.g. aminoglycosides, clindamycin, colistin, cyclopropane, halogenated inhalational anaesthetics. Effects may be reduced by quinine, chloroquine, hydroxychloroquine, quinidine, procainamide, propafenone, lithium, β-blockers. Possible additive toxicity with ophthalmic use of anticholinesterases e.g. ecothiopate.
See Below for More neostigmine Drug Interactions
Mechanism of Actions
Neostigmine reversibly inhibits acetylcholinesterase and thus potentiates the nicotinic and muscarinic effects of acetylcholine. This facilitates the transmission of impulses across myoneural junction.
Onset: IM: 20-30 min. IV: 1-20 min.
Duration: IM: 2.5-4 hr. IV: 1-2 hr.
Absorption: Poorly absorbed from the GI tract (oral).
Distribution: CNS (poor penetration), crosses the placenta and enters breast milk (small amounts). Protein-binding: 15-25%.
Metabolism: Hepatic; hydrolysis by cholinesterases.
Excretion: Parenteral: Rapidly eliminated via urine (as unchanged drug and metabolites).
Storage Conditions
Intramuscular: Store at 15-30°C. Protect from light. Do not freeze. Intravenous: Store at 15-30°C. Protect from light. Do not freeze. Oral: Store at 15-30°C. Parenteral: Store at 15-30°C. Protect from light. Do not freeze.
ATC Classification
N07AA01 - neostigmine ; Belongs to the class of anticholinesterase. Used as parasympathomimetics.
S01EB06 - neostigmine ; Belongs to the class of parasympathomimetics. Used in the treatment of glaucoma and miosis.
Storage
Intramuscular: Store at 15-30°C. Protect from light. Do not freeze. Intravenous: Store at 15-30°C. Protect from light. Do not freeze. Oral: Store at 15-30°C. Parenteral: Store at 15-30°C. Protect from light. Do not freeze.
Available As
  • Neostigmine 0.5 mg
  • Neostigmine Methyl Sulphate 0.5 mg
  • Neostigmine 12.5 mg
  • Neostigmine 15 mg
  • Neostigmine Methyl Sulphate 2.5 mg
  • Neostigmine 2.5 mg
  • Subscribe for latest updates

    Subscribe to our e-mail newsletter to receive updates.

    No comments yet.

    Post Review about Neostigmine


    Neostigmine Containing Brands

    We are Developing Our database, More results coming soon.

    Neostigmine is used in following diseases

    We are Developing Our database, More results coming soon.

    Drug - Drug Interactions of Neostigmine

    We are Developing Our database, More results coming soon.