- 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
- Adult:
-
- 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
- Children:
- 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)
- Prevention: IM 0.25mg after surgery
- 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 |