Neostigmine (Prostigmin)

Category:

• Cholinergic Muscle Stimulant

Description:

• Antimyasthenic

Indications:

• Myasthenia gravis

• Neuromuscular blockade

• Urinary Retention

Contraindications:

• No labeled contraindications

Precautions:

• Pregnancy category C

Adverse Reactions (Side Effects):

• Frequent: diarrhea, sweating, watery mouth, nausea, vomiting, stomach pain/cramps

• Less frequent: increased bronchial secretions, urinary frequency, watery eyes

Dosage:

Administered orally (tablets, syrup), subcutaneously, intramuscularly, intravenously

• Adult: 

  • Myasthenia gravis: 

    • PO 15mg every 3-4 hours, the dose and frequency adjusted as needed.  Maintenance; 150mg daily, the intervals of the doses determined by the patient response. 

    • IM/SQ 500mcg, subsequent doses based on patient response. Subsequent doses may be less than 500mcg. IV 500mcg to 2mg administered slowly, repeated as required up to 5mg  

    • Note: When neostigmine is administered IV, recommend 0.6-1.2mg atropine be administered IV prior to or concurrently to counteract muscarinic side effects. 

  • Postoperative urinary retention: 

    • IM/SQ 500mcg every 3 hours as needed; maximum of 5 doses before catherization

  • Antidote: (to nondepolarizing neuromuscular blockade) 

    • IV 500mcg to 2mg, repeated as required up to 5mg. Use atropine concomitantly as stated above.

• Child: 

  • Myasthenia gravis: 

    • PO 2 mg/kg divided into 6-8 doses daily

    • IM/SQ 10-40mcg per kg body weight every 2 to 3 hours.  

    • Note: co-administer or administer on alternate doses 10mcg atropine to counteract muscarinic side effects.