Class: Anticholinesterase ' reversal of muscle relaxant
Trade names: Neostigmine
Pregnancy: (Category C)
reverse cholinesterase inhibitor. By interfering with the breakdown of acetylcholine, Neostigmine indirectly stimulates both nicotinic and muscarinic receptors
The symptomatic control of myasthenia gravis when oral therapy is impractical.
The prevention and treatment of postoperative distention and urinary retention after mechanical obstruction has been excluded.
Reversal of effects of nondepolarizing neuromuscular blocking agents (e.g., tubocuranne, metocurine, gallamine or pancuronium) after surgery.
reversal of non-depolarising neuromuscular blockade, by intravenous injection over 1 minute, 50–70 micrograms/kg (max. 5 mg) after or with atropine sulfate 0.6–1.2 mg
Neostigmine Methylsulfate Injection is contraindicated in patients with known hypersensitivity to the drug. It is also contraindicated in patients with peritonitis or mechanical obstruction of the intestinal or urinary tract.
Dizziness, convulsions, loss of consciousness, drowsiness, headache, dysarthria, miosis and visual changes.
Cardiac arrhythmias .
Rash and urticaria.
Nausea, emesis, flatulence and increased peristalsis.
Diaphoresis, flushing and weakness.
Neostigmine Methylsulfate Injection should be used with caution in patients with epilepsy, bronchial asthma, bradycardia, recent coronary occlusion, vagotonia, hyperthyroidism, cardiac arrhythmias or peptic ulcer.
When large doses of Neostigmine Methylsulfate Injection are administered, the prior or simultaneous injection of atropine sulfate may be advisable.
Separate syringes should be used for the neostigmine methylsulfate and atropine. Because of the possibility of hypersensitivity in an occasional patient, atropine and antishock medication should always be readily available.