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NERVOUS SYSTEM › OTHER NERVOUS SYSTEM DRUGS › PARASYMPATHOMIMETICS › Anticholinesterases
neostigmine, combinations
N07AA51
Forms & Strengths
- Injectable solution: 0.5 mg/mL, 1 mg/mL
Adult Dosing
- Reversal of nondepolarizing neuromuscular blockade: 0.05 to 0.07 mg/kg IV administered slowly, usually with an anticholinergic such as atropine or glycopyrrolate; max total dose 5 mg
- Myasthenia gravis symptomatic treatment: 0.5 to 2.5 mg IM or SC every 1 to 3 hours as required
Pediatric Dosing
- Reversal of neuromuscular blockade: 0.03 to 0.07 mg/kg IV along with an anticholinergic agent; max dose 0.07 mg/kg or 5 mg total
Indications
- Reversal of effects of nondepolarizing neuromuscular blocking agents after surgery
- Symptomatic management of myasthenia gravis
Mechanism of Action
- Inhibits the destruction of acetylcholine by acetylcholinesterase, facilitating accumulation of acetylcholine at cholinergic receptor sites and prolonging its action
Contraindications
- Known hypersensitivity to neostigmine
- Peritonitis or mechanical intestinal and urinary obstruction
Adverse Reactions
- Bradycardia, hypotension, arrhythmias
- Bronchospasm, increased bronchial and salivary secretions
- Nausea, vomiting, diarrhea, abdominal cramps, increased peristalsis
- Muscle cramps, fasciculations, weakness
- Miosis, diaphoresis, lacrimation
Drug Interactions
- Nondepolarizing neuromuscular blockers: antagonism of neuromuscular blockade effect
- Depolarizing neuromuscular blockers (e.g., succinylcholine): phase II block or prolonged effect may occur
- Beta-blockers and calcium channel blockers: potential for additive bradycardia
- Aminoglycoside antibiotics and local anesthetics: may antagonize the effect of neostigmine on myasthenia gravis
Curated Content: Needs Vetting Before Put to Clinical Use