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.
Oral Paralytic ileus and postoperative urinary retention Adult: As bromide: 15-30 mg.
Oral Neonatal myasthenia gravis Child: As bromide: 1-5 mg every 4 hr.
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.
Parenteral Paralytic ileus and postoperative urinary retention Adult: As metilsulfate: 0.5 mg IM/SC.
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.
Parenteral Neonatal myasthenia gravis Child: As metilsulfate: 50-250 mcg IM/SC every 4 hr.
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. |
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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. |
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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 |
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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). |
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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. |
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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 |
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Neostigmine
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Neostigmine Containing Brands
Neostigmine is used in following diseases
Drug - Drug Interactions of Neostigmine
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