P  - Caution when used during pregnancy

L  - Caution when used during lactation

Molecule Info

 
Indication & Dosage 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
10-50 50% of normal dose.
<10 25% of normal dose.

Oral
Paralytic ileus and postoperative urinary retention
Adult: As bromide: 15-30 mg.
CrCl (ml/min) Dosage Recommendation
10-50 50% of normal dose.
<10 25% of normal dose.

Oral
Neonatal myasthenia gravis
Child: As bromide: 1-5 mg every 4 hr.
CrCl (ml/min) Dosage Recommendation
10-50 50% of normal dose.
<10 25% 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
10-50 50% of normal dose.
<10 25% of normal dose.

Parenteral
Paralytic ileus and postoperative urinary retention
Adult: As metilsulfate: 0.5 mg IM/SC.
CrCl (ml/min) Dosage Recommendation
10-50 50% of normal dose.
<10 25% 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
10-50 50% of normal dose.
<10 25% of normal dose.

Parenteral
Neonatal myasthenia gravis
Child: As metilsulfate: 50-250 mcg IM/SC every 4 hr.
CrCl (ml/min) Dosage Recommendation
10-50 50% of normal dose.
<10 25% 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.
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: Anaphylaxis.
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. 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: 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.
Pharmacology 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).
ATC Classification S01EB06 - neostigmine; Belongs to the class of parasympathomimetics used in the treatment of glaucoma and miosis. 
N07AA01 - neostigmine; Belongs to the class of anticholinesterase used as parasympathomimetics.

 

Brand/Product Info


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