What you need to know about drugs

Neostigmine

Neostigmine

Generic Name: neostigmine (nee-oh-STIG-meen)

Brand Name: Prostigmin

OverviewSide EffectsInteractionsFor ProfessionalsMore…

Neostigmine is used for:

Treating myasthenia gravis. It may also be used for other conditions as determined by your doctor.

Neostigmine is a cholinesterase inhibitor. It works by improving the transmission of nerve impulses in muscles so that the muscles are better able to work.

Do NOT use neostigmine if:

  • you are allergic to any ingredient in neostigmine
  • you are taking procainamide, a quinine derivative (eg, quinidine), or succinylcholine

Contact your doctor or health care provider right away if any of these apply to you.

Before using neostigmine:

Some medical conditions may interact with neostigmine. Tell your doctor or pharmacist if you have any medical conditions, especially if any of the following apply to you:

  • if you are pregnant, planning to become pregnant, or are breast-feeding
  • if you are taking any prescription or nonprescription medicine, herbal preparation, or dietary supplement
  • if you have allergies to medicines, foods, or other substances
  • if you have a heart blockage, a slow heartbeat, a blockage of the intestines, or a urinary tract obstruction or infection

Some MEDICINES MAY INTERACT with neostigmine. Tell your health care provider if you are taking any other medicines, especially any of the following:

  • General anesthetics (eg, cyclopropane), procainamide, or quinine derivatives (eg, quinidine) because they may decrease the effectiveness of neostigmine
  • Beta-blockers (eg, propanolol) or succinylcholine because side effects may be increased by neostigmine

This may not be a complete list of all interactions that may occur. Ask your health care provider if neostigmine may interact with other medicines that you take. Check with your health care provider before you start, stop, or change the dose of any medicine.

How to use neostigmine:

Use neostigmine as directed by your doctor. Check the label on the medicine for exact dosing instructions.

  • Neostigmine may be taken with or without food. If stomach upset occurs, take with food to reduce stomach irritation.
  • If you miss a dose of neostigmine, take it as soon as possible. If it is almost time for the next dose, skip the missed dose and go back to your regular dosing schedule. Do not take 2 doses at once.

Ask your health care provider any questions you may have about how to use neostigmine.

Important safety information:

  • Neostigmine may cause drowsiness, dizziness, blurred vision, or fainting. Do not drive, operate machinery, or do anything else that could be dangerous until you know how you react to neostigmine. Using neostigmine alone, with certain other medicines, or with alcohol may lessen your ability to drive or perform other potentially dangerous tasks.
  • Before you have any medical or dental treatments, emergency care, or surgery, tell the doctor or dentist that you are using neostigmine.
  • PREGNANCY and BREAST-FEEDING: If you become pregnant, discuss with your doctor the benefits and risks of using neostigmine during pregnancy. It is unknown if neostigmine is excreted in breast milk. If you are or will be breast-feeding while you are using neostigmine, check with your doctor or pharmacist to discuss the risks to your baby.

Possible side effects of neostigmine:

All medicines may cause side effects, but many people have no, or minor, side effects. Check with your doctor if any of these most COMMON side effects persist or become bothersome:

Abdominal cramps; diarrhea; difficulty speaking; dilation of pupils; dizziness; drowsiness; excess saliva; frequent urination; gas; headache; increased sweating; joint pain; muscle twitching; weakness.

Seek medical attention right away if any of these SEVERE side effects occur:

Severe allergic reactions (rash; itching; hives; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); fainting; increased muscle weakness; interrupted breathing; irregular heartbeat; seizures; vision changes.

This is not a complete list of all side effects that may occur. If you have questions about side effects, contact your health care provider. Call your doctor for medical advice about side effects. To report side effects to the appropriate agency, please read the Guide to Reporting Problems to FDA.

If OVERDOSE is suspected:

Contact 1-800-222-1222 (the American Association of Poison Control Centers), your local poison control center, or emergency room immediately. Symptoms may include blurred vision; cold sweating; difficulty swallowing; panic; severe anxiety; stomach cramps; vomiting.

Proper storage of neostigmine: Store neostigmine at room temperature, between 59 and 86 degrees F (15 and 30 degrees C), in a tightly closed container. Store away from heat, moisture, and light. Do not store in the bathroom. Keep neostigmine out of the reach of children and away from pets.

General information:

  • If you have any questions about neostigmine, please talk with your doctor, pharmacist, or other health care provider.
  • Neostigmine is to be used only by the patient for whom it is prescribed. Do not share it with other people.
  • If your symptoms do not improve or if they become worse, check with your doctor.
  • Check with your pharmacist about how to dispose of unused medicine.

This information should not be used to decide whether or not to take neostigmine or any other medicine. Only your health care provider has the knowledge and training to decide which medicines are right for you. This information does not endorse any medicine as safe, effective, or approved for treating any patient or health condition. This is only a brief summary of general information about neostigmine. It does NOT include all information about the possible uses, directions, warnings, precautions, interactions, adverse effects, or risks that may apply to neostigmine. This information is not specific medical advice and does not replace information you receive from your health care provider. You must talk with your healthcare provider for complete information about the risks and benefits of using neostigmine.

Issue Date: March 6, 2013 Database Edition 13.1.1.003 Copyright © 2013 Wolters Kluwer Health, Inc.

Post a Comment

Your email is kept private. Required fields are marked *

You may use these HTML tags and attributes: <a href="" title=""> <abbr title=""> <acronym title=""> <b> <blockquote cite=""> <cite> <code> <del datetime=""> <em> <i> <q cite=""> <strike> <strong>

neostigmine

neostigmine

Generic Name: neostigmine (nee o STIG meen)

Brand Name: Prostigmin Bromide, Prostigmin

OverviewSide EffectsInteractionsFor ProfessionalsMore…

What is neostigmine?

Neostigmine affects chemicals in the body that are involved in the communication between nerve impulses and muscle movement.

Neostigmine is used to treat the symptoms of myasthenia gravis.

Neostigmine may also be used for purposes not listed in this medication guide.

What is the most important information I should know about neostigmine?

You should not use this medication if you are allergic to neostigmine or pyridostigmine (Mestinon), or if you have a bladder or bowel obstruction, or a serious stomach disorder called peritonitis.

Before taking neostigmine, tell your doctor if you have asthma, kidney disease, slow heartbeats or other heart rhythm disorder, high blood pressure, heart disease, coronary artery disease, an ulcer or other serious stomach disorder, overactive thyroid, or a history of seizures.

The amount and timing of this medicine is extremely important to the success of your treatment. Carefully follow your doctor’s instructions about how much medicine to take and when to take it. You may need to take neostigmine at evenly spaced intervals around the clock.

This medication may cause blurred vision or impair your thinking or reactions. Be careful if you drive or do anything that requires you to be alert and able to see clearly.

Your doctor may occasionally change your dose to make sure you get the best results. You may be asked to keep a daily record of when you took each dose and how long the effects lasted. This will help your doctor determine if your dose needs to be adjusted.

If you need surgery, tell the surgeon ahead of time that you are using neostigmine. You may need to stop using the medicine for a short time.

What should I discuss with my healthcare provider before taking neostigmine?

You should not use this medication if you are allergic to neostigmine or pyridostigmine (Mestinon), or if you have a bladder or bowel obstruction, or a serious stomach disorder called peritonitis.

To make sure you can safely take neostigmine, tell your doctor if you have any of these other conditions:

  • asthma;

  • kidney disease;
  • slow heartbeats or other heart rhythm disorder;
  • high blood pressure, heart disease, coronary artery disease;
  • an ulcer or other serious stomach disorder;
  • overactive thyroid; or
  • a history of seizures.

FDA pregnancy category C. It is not known whether neostigmine will harm an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant while using this medication. You should not take neostigmine during late pregnancy.

It is not known whether neostigmine passes into breast milk or if it could harm a nursing baby. You should not breast-feed while you are using neostigmine.

How should I take neostigmine?

Take exactly as prescribed by your doctor. Do not take in larger or smaller amounts or for longer than recommended. Follow the directions on your prescription label.

Take this medicine with food or milk if it upsets your stomach.

Do not crush, chew, or break an extended-release tablet. Swallow it whole. Breaking or opening the pill may cause too much of the drug to be released at one time.

The amount and timing of this medicine is extremely important to the success of your treatment. Carefully follow your doctor’s instructions about how much medicine to take and when to take it. You may need to take neostigmine at evenly spaced intervals around the clock.

Your doctor may occasionally change your dose to make sure you get the best results. You may be asked to keep a daily record of when you took each dose and how long the effects lasted. This will help your doctor determine if your dose needs to be adjusted.

If you need surgery, tell the surgeon ahead of time that you are using neostigmine. You may need to stop using the medicine for a short time.

Store at room temperature away from moisture, heat, and light.

What happens if I miss a dose?

Take the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not take extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.

Overdose symptoms may include nausea, vomiting, diarrhea, stomach cramps, sweating, blurred vision, drooling, and weak or shallow breathing.

Worsening muscle weakness, or no change in your myasthenia gravis symptoms, may also be signs of overdose.

What should I avoid while taking neostigmine?

This medication may cause blurred vision or impair your thinking or reactions. Be careful if you drive or do anything that requires you to be alert and able to see clearly.

Drinking alcohol can increase drowsiness caused by neostigmine.

Neostigmine side effects

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Stop using neostigmine and call your doctor at once if you have any of these serious side effects:

  • extreme muscle weakness;

  • slurred speech, vision problems;
  • feeling like you might pass out;
  • severe stomach cramps or diarrhea;
  • trouble breathing, cough with mucus;
  • fast or slow heart rate;
  • seizure (convulsions); or
  • worsening or no improvement in your symptoms of myasthenia gravis.

Less serious side effects may include:

  • headache, drowsiness;

  • mild nausea, vomiting, gas;
  • urinating more than usual;
  • cold sweat, warmth or tingly feeling; or
  • mild rash or itching.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

See also: neostigmine side effects (in more detail)

What other drugs will affect neostigmine?

Tell your doctor about all other medicines you use, especially:

  • atropine (Atreza, Sal-Tropine);

  • belladonna (Donnatal, and others);
  • benztropine (Cogentin);
  • clidinium (Quarzan);
  • clozapine (Clozaril, FazaClo);
  • dimenhydrinate (Dramamine);
  • methscopolamine (Pamine), scopolamine (Transderm Scop);
  • glycopyrrolate (Robinul);
  • mepenzolate (Cantil);
  • an antibiotic such as neomycin (Mycifradin, Neo Fradin, Neo Tab), kanamycin (Kantrex), or streptomycin, tobramycin (Nebcin, Tobi);
  • bladder or urinary medications such as darifenacin (Enablex), flavoxate (Urispas), oxybutynin (Ditropan, Oxytrol), tolterodine (Detrol), or solifenacin (Vesicare);
  • bronchodilators such as ipratropium (Atrovent) or tiotropium (Spiriva);
  • cold medicine, allergy medicine, or sleeping pills that contain an antihistamine such as diphenhydramine (Tylenol PM) or doxylamine (Unisom);
  • heart rhythm medication such as quinidine (Quin-G), procainamide (Procan, Pronestyl), disopyramide (Norpace), flecaininde (Tambocor), mexiletine (Mexitil), propafenone, (Rythmol), and others;
  • irritable bowel medications such as dicyclomine (Bentyl), hyoscyamine (Hyomax), or propantheline (Pro Banthine);
  • medicine to treat Alzheimer’s dementia, such as donepezil (Aricept), rivastigmine (Exelon), or tacrine (Cognex); or
  • a steroid such as betamethasone (Celestone) or dexamethasone (Cortastat, Dexasone, Solurex, DexPak).

This list is not complete and other drugs may interact with neostigmine. Tell your doctor about all medications you use. This includes prescription, over-the-counter, vitamin, and herbal products. Do not start a new medication without telling your doctor.

Next Page → Side Effects

More neostigmine resources

  • Side Effects
  • Drug Interactions
  • Support Group
  • 0 Reviews - Add your own review/rating
  • neostigmine MedFacts Consumer Leaflet (Wolters Kluwer)
  • neostigmine Injection Advanced Consumer (Micromedex) – Includes Dosage Information
  • Neostigmine Professional Patient Advice (Wolters Kluwer)
  • Neostigmine Bromide Monograph (AHFS DI)
  • neostigmine Advanced Consumer (Micromedex) – Includes Dosage Information

Compare neostigmine with other medications

  • Myasthenia Gravis

Where can I get more information?

  • Your pharmacist can provide more information about neostigmine.

Post a Comment

Your email is kept private. Required fields are marked *

You may use these HTML tags and attributes: <a href="" title=""> <abbr title=""> <acronym title=""> <b> <blockquote cite=""> <cite> <code> <del datetime=""> <em> <i> <q cite=""> <strike> <strong>

Neostigmine

Neostigmine

Pronunciation: NEE-oh-STIG-meen

Class: Anticholinesterase muscle stimulant

For ProfessionalsSide EffectsInteractionsMore…

Trade Names

Prostigmin

– Tablets 15 mg

– Injection 1:1,000

– Injection 1:2,000

– Injection 1:4,000

Pharmacology

Facilitates myoneural junction impulse transmission by inhibiting acetylcholine destruction by cholinesterase.

Pharmacokinetics

Absorption

Rapid absorption of neostigmine methylsulfate; neostigmine bromide is poorly absorbed from the GI tract. T max is 30 min (IV) and 1 to 2 h (oral).

Distribution

Neostigmine protein binding is 15% to 25% (serum albumin).

Metabolism

Neostigmine is metabolized in the liver by microsomal enzymes and undergoes hydrolysis by cholinesterase.

Elimination

Neostigmine is eliminated in urine (50% as unchanged). Half-life is 51 to 90 min and plasma half-life is 47 to 60 min (IV); half-life ranges from 42 to 60 min, with a mean half-life of 52 min (oral).

Onset

Onset of IM neostigmine is 20 to 30 min.

Duration

Duration of IM neostigmine is 2.5 to 4 h.

Indications and Usage

Symptomatic control of myasthenia gravis; antidote for nondepolarizing neuromuscular blocking agents after surgery; prevention and treatment of postoperative distention and urinary retention (IV only).

Contraindications

Hypersensitivity to anticholinesterases and bromides; mechanical intestinal or urinary obstruction; peritonitis.

Dosage and Administration

Antidote

Adults IV 0.5 to 2 mg by slow infusion repeated as needed, preceded by 0.6 to 1.2 mg of atropine sulfate. May be repeated as needed up to total dose of 5 mg.

Myasthenia Gravis

Adults PO 15 to 375 mg/day; Subcutaneous/IM 1 mL of 1:2,000 solution (0.5 mg); individualize subsequent doses.

Prevention of Postoperative Urinary Distention and Retention

Adults Subcutaneous / IM 1 mL of 1:4,000 solution (0.25 mg) after surgery; repeat every 4 to 6 h for 2 or 3 days.

Treatment of Postoperative Distention

Adults Subcutaneous / IM 1 mL of 1:2,000 solution (0.5 mg), as required.

Treatment of Urinary Retention

Adults Subcutaneous / IM 1 mL of 1:2,000 solution (0.5 mg) after bladder is emptied; continue 0.5 mg injection every 3 h for at least 5 injections.

General Advice

  • Injection
  • For IV, subcutaneous, or IM administration. Not for intradermal or intra-arterial administration.
  • Do not administer if particulate matter or discoloration is noted.
  • Patients on IV neostigmine can be transferred to the oral form as soon as it can be tolerated.
  • Tablets
  • Administer as prescribed. Size of dose (eg, number of tablets) and frequency of administration will be adjusted to provide max relief of myasthenia gravis symptoms.
  • Administer without regard to meals. Administer with food if GI upset occurs.
  • Larger portions of the daily dose may be given at times when the patient is more prone to fatigue (eg, afternoons, mealtimes).
  • Large doses should be avoided in situations where there might be an increased absorption rate from the intestinal tract.
  • Ensure that parenteral atropine is available for emergency treatment of cholinergic crisis.

Storage/Stability

Store at 59° to 86°F. Keep injection in carton until ready to use and protect from light.

Drug Interactions

Anticholinergic agents (eg, atropine, belladonna) Intestinal motility may be slowed, increasing neostigmine absorption. Use with caution. Adjust the neostigmine dose as needed.

Beta-blockers (eg, propranolol) Severe or prolonged bradycardia may occur because of additive pharmacologic effects. Use with caution. Larger dosages of atropine and sympathomimetic pressor agents may be needed to reverse bradycardia and hypotension.

Corticosteroids (eg, corticotropin, hydrocortisone) The effects of neostigmine may be decreased. In addition, the effects of neostigmine may be increased after corticosteroids are discontinued. Provide mechanical respiratory support if needed.

Drugs that interfere with neuromuscular transmission May interfere with neuromuscular transmission. Use with caution in myasthenic patients. Monitor the patient and increase the neostigmine dose as needed.

Kanamycin, streptomycin Neuromuscular blockade may be enhanced. Use these antibiotics in myasthenic patients only when clearly indicated. Closely monitor the patient. Adjust the neostigmine dose as needed.

Local/General anesthetics, antiarrhythmic agents (eg, procainamide) Use with caution in myasthenic patients; may interfere with neuromuscular transmission. Increase the neostigmine dose as needed.

Quinine Quinine may antagonize the effects of neostigmine. Avoid using quinine in patients receiving neostigmine for myasthenia gravis.

Succinylcholine Neuromuscular blockade produced by succinylcholine may be prolonged. Avoid this combination in the presence of a depolarizing (phase 1) type of neuromuscular blockade. Use with caution if a nondepolarizing (phase 2) type of blockade is present. Provide mechanical respiratory support as needed.

Laboratory Test Interactions

None well documented.

Adverse Reactions

Cardiovascular

Arrhythmia (AV block, bradycardia, nodal rhythm, tachycardia); cardiac arrest; hypotension; nonspecific ECG changes; syncope.

CNS

Convulsions; dizziness; drowsiness; dysarthria; dysphonia; headache; loss of consciousness.

Dermatologic

Diaphoresis; flushing; rash; urticaria.

EENT

Miosis; vision changes.

GI

Bowel cramps; diarrhea; emesis; flatulence; increased peristalsis; nausea; salivation; vomiting.

Genitourinary

Urinary frequency.

Respiratory

Dyspnea; increased oral, pharyngeal, and bronchial secretions; respiratory arrest, respiratory depression, and bronchospasm (IV).

Musculoskeletal

Arthralgia; muscle cramps and spasms.

Miscellaneous

Allergy and anaphylaxis; fasciculations; weakness.

Precautions

Monitor

Frequently assess muscle strength and function in patient with myasthenia gravis or patient recovering from nondepolarizing neuromuscular blocking agent.

Pregnancy

Category C .

Lactation

Undetermined.

Children

Safety and efficacy not established.

Hypersensitivity

Anaphylaxis may occur. Have atropine and antishock medications available.

Special Risk Patients

Use with caution in patients with bradycardia, bronchial asthma, cardiac arrhythmias, epilepsy, hyperthyroidism, peptic ulcer, recent coronary occlusion, or vagotonia.

Anticholinesterase insensitivity

May develop.

Overdosage

Symptoms

Abdominal cramps, anxiety, diarrhea, excessive salivation, miosis, panic attacks, progressive muscle weakness leading to paralysis and death, sweating, urinary urgency.

Patient Information

  • Advise patient or caregiver that injection will be prepared and administered by a health care provider in a medical setting.
  • Advise patient that dose and frequency of administration may be adjusted to achieve max benefit.
  • Advise patient to take prescribed oral dose without regard to meals, but to take with food if stomach upset occurs.
  • Advise patient with myasthenia gravis to keep a diary of medication administration times and times when muscle weakness or other symptoms occur. This log will help the health care provider adjust the dose and dosing interval to establish the most effective dose and times of administration.
  • Instruct patient to contact health care provider immediately if any of the following occur: difficulty breathing, dizziness, fainting, severe abdominal pain, slow or irregular heart rate, vomiting, worsening muscle weakness.
  • Advise patient that diarrhea, increased salivation, nausea, and sweating are common adverse reactions and to notify health care provider if any occur and are bothersome.

Copyright © 2009 Wolters Kluwer Health.

Post a Comment

Your email is kept private. Required fields are marked *

You may use these HTML tags and attributes: <a href="" title=""> <abbr title=""> <acronym title=""> <b> <blockquote cite=""> <cite> <code> <del datetime=""> <em> <i> <q cite=""> <strike> <strong>