• Mysthaenia gravis:
    • Adult:
      • Acute: IV/IM/SC 0.5-2.5mg OD
      • Maintenance: PO 15-375mg/day divided TDS/QID
      • Use injectable with IV 0.6-1.2mg atropine to counteract muscarinic effects
    • Children:
      • IV/IM/SC 01-0.04 mg/kg every 2-3 hours PRN OR
      • PO 2mg/kg/day divided 4-hourly
      • Max 375mg/day
  • Reversal of nondepolarizing neuromuscular blockade reversal:
    • IV 0.03-0.07mg/kg/dose *1
    • Max: 0.07mg/kg up to 5 mg total dose
  • Post-op distension or urinary retention:
    • Prevention: IM 0.25mg after surgery
      • Repeated every 4-6 hours *2-3 days
    • Treatment: IM 0.5-1mg and up to every 3 hours PRN (for 5 doses for retention)
  • Injection:
    • 2.5mg/mL
    • 0.5mg/mL
  • Tablet:
    • 15mg

Give IV slowly

Neuromuscular blocker

It is a competitive inhibitor of cholinesterase resulting in decreased hydrolysis of acetylcholine by cholinesterase

By reducing the breakdown of acetylcholine, neostigmine increases acetylcholine in the synaptic cleft which competes for the same binding site as nondepolarizing neuromuscular blocking agents thereby causing reversal of neuromuscular blockade

  • Sialorrhea
  • Fasciculation
  • Abdominal cramps
  • Abdominal distension
  • Loose stools
  • Diarrhea
  • Flatulence
  • Headache
  • Dizziness
  • Diaphoresis
  • Increased lacrimation
  • Increased pulmonary secretions
  • Dyspnea
  • Nausea
  • Vomiting
  • Urinary frequency
  • Urinary urgency
  • Muscle cramps
  • Muscle weakness
  • Miosis
  • Vision changes
  • Pruritus
  • Rash
  • Drowsiness
  • Flushing
  • Dysarthria
  • Weakness
  • Arthralgia
  • Tachycardia
  • Xerostomia
  • Insomnia
  • Rigors
  • Hypersensitivity reactions
  • GI obstruction
  • GU tract obstruction
  • Peritonitis

None restricted

                          Drug Status

Availability Prescription only
Pregnancy Weigh risk vs benefit
Breastfeeding Not indicated
Schedule Not controlled
BRAND NAME STRENGTH FORMULATION PACK SIZE MANUFACTURER DISTRIBUTOR
Myostigmin 2.5mg/mL Injection 10’s M/S.Neon Labs Ripple Pharma
Neostigmine 2.5mg/mL Injection 10’s Fresenius Kabi Surgipharm Ltd
Neostigmine 2.5mg/mL Injection 100’s Laboratoire Renaudin Nairobi Pharma
Neostigmine 2.5mg/mL Injection 10’s Fresenius Kabi Surgipharm Ltd
Stigmed 2.5mg/mL Injection 1’s Medisel Kenya Medisel Kenya
Stigmine 2.5mg/mL Injection 5’s Primal Healthcare Galaxy Pharma
Stigvita-H 2.5mg/mL Injection 10’s Reddys Pharma Reddys Pharma
Tilstigmin 2.5mg/mL Injection 10’s Til Healthcare Harley’s Ltd