P Â - Caution when used during pregnancy
L Â - Caution when used during lactation
|Indication & Dosage||Oral
Adult:Â 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:Â As bromide: 2 mg/kg daily, divided into doses and given every 3-4 hr. Total daily dose is 15-90 mg.
Paralytic ileus and postoperativeÂ urinary retention
Adult:Â As bromide: 15-30 mg.
Neonatal myasthenia gravis
Child:Â As bromide: 1-5 mg every 4 hr.
Adult:Â As metilsulfate: 0.5-2.5 mg IM/SC at intervals, up to a total daily dose of 5-20 mg.
Child:Â As metilsulfate: 200-500 mcg IM/SC as single daily dose.
Paralytic ileus and postoperative urinary retention
Adult:Â As metilsulfate: 0.5 mg IM/SC.
Reversal of neuromuscular blockade
Adult:Â 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:Â As metilsulfate: Children: 0.025-0.08 mg/kg/dose. Infants: 0.025-0.1 mg/kg/dose.
Neonatal myasthenia gravis
Child:Â As metilsulfate: 50-250 mcg IM/SC every 4 hr.
Diagnosis of myasthenia gravis
Adult:Â As metilsulfate: 0.02 mg/kg as a single dose. Discontinue all anticholinesterase medications for at least 8 hr prior to admin.
Child:Â As metilsulfate: 0.04 mg/kg as a single dose. Discontinue all anticholinesterase medications for at least 8 hr prior to admin.
Adult:Â Instil 1-2 drops of 0.5% solution into the eyes 1-4 times daily.
|Overdosage||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.|
|Contraindications||Mechanical GI or urinary tract obstruction, peritonitis.|
|Special 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 Drug 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:Â Anaphylaxis.
|Drug Interactions||May reduce effects of anticholinergics. May increase effects of cholinergic agonists. Increased risk of bradycardia with digoxin,
diltiazem, verapamil or Î²-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, Î²-blockers. Possible additive toxicity with ophthalmic use of anticholinesterases e.g.
ecothiopate.Â Please consult detailed drug interactions before prescribing.
|Pregnancy Category (US FDA)||Category C: Either studies in animals have revealed adverse effects on the foetus (teratogenic or embryocidal or other) and there are no controlled studies in women or studies in women and animals are not available. Drugs should be given only if the potential benefit justifies the potential risk to the foetus.|
|Storage||Intramuscular:Â Store at 15-30Â°C. Protect from light. Do not freeze.Intravenous:Â Store at 15-30Â°C. Protect from light. Do not freeze.Â Oral:Â Store at 15-30Â°C.Â Parenteral:Â Store at 15-30Â°C. Protect from light. Do not freeze.|
|Pharmacology||Neostigmine reversibly inhibits
acetylcholinesterase and thus potentiates the nicotinic and muscarinic effects of acetylcholine. This facilitates the transmission of impulses across
Onset:Â IM: 20-30 min. IV: 1-20 min.
Duration:Â IM: 2.5-4 hr. IV: 1-2 hr.
Absorption:Â Poorly absorbed from the GI tract (oral).
Distribution:Â CNS (poor penetration), crosses the placenta and enters breast milk (small amounts). Protein-binding: 15-25%.
Metabolism:Â Hepatic; hydrolysis by cholinesterases.
Excretion:Â Parenteral: Rapidly eliminated via urine (as unchanged drug and metabolites).
|ATC Classification||S01EB06 - neostigmine; Belongs to the class of parasympathomimetics used in the treatment of glaucoma and miosis.Â
N07AA01 - neostigmine; Belongs to the class of anticholinesterase used as parasympathomimetics.
Total Products : 7
|Brand Name||Manufacturer/Marketer||Composition||Dosage Form||Pack Size & Price|
|G-NEOSTIGMINE||Gonoshasthaya Pharmaceuticals Ltd||Neostigmine methylsulphate 0.5mg/1ml||Injection||5 amps: 30.25 MRP|
|NEOS-R||Renata Limited||Neostigmine methylsulphate 0.5mg/1ml||Injection||ml amp x5's: 40.15 MRP|
|NEOSTIG||Popular Pharmaceuticals Ltd.||Neostigmine methylsulphate 0.5mg/1ml||Injection||ml amp x5's: 30.25 MRP|
|PROSTIG||Chemist Laboratories Ltd.||Neostigmine methylsulphate 0.5mg/1ml||Injection||ml amp x10's: 80.00 MRP|
|STIGMTN||Techno Drugs||Neostigmine methylsulphate 0.5mg/1ml||Injection||ml amp x10's: 60.00 MRP|
|STIGNAL||ACI Ltd.||Neostigmine methylsulphate 0.5mg/1ml||Injection||ml amp x5's: 30.25 MRP|
|VERSIA||Square Pharmaceuticals Ltd.||Neostigmine Methyl Sulphate 0.5mg/ml||IM/IV Injection||2x5's: 70.40 MRP|