Adult Dosing

Myasthenia gravis

• Start: 15 mg PO q3–4 hrs; increase dose at daily intervals until optimal response is achieved
• Maintenance dose: 150 mg/day PO. Max: 375 mg/day PO PRN

• Symptomatic treatment of myasthenia gravis

• Hypersensitivity to any of the ingredients of the product
• Hypersensitivity to bromides
• GI obstruction
• GU tract obstruction
• Peritonitis

• N/A

Renal Dose Adjustment (Based on CrCl)

• 10-25 mL/min: Decrease dose to 50%
• <10 mL/min: Decrease dose to 25%

Hepatic Dose Adjustment

• Hepatic impairment: Dose adjustments not defined

• Overdosage of therapy may result in cholinergic crisis which is characterized by increasing muscle weakness and which may lead to death
• Observe patients closely for cholinergic reactions; differentiation from myasthenic crisis is important because increasing the dose of neostigmine may have grave consequences in patients in cholinergic crisis
• Use smaller dosage in patients with renal disease as neostigmine is mainly excreted unchanged by the kidney

Cautions: Use cautiously in

• Renal impairment
• Hx of asthma
• COPD
• Peptic ulcer disease
• GERD
• CV disease
• Bradycardia
• Arrhythmias
• Cardiac conduction defects
• Hx of epilepsy
• Hyperthyroidism

Pregnancy Category:C

Breastfeeding: Probably safe. Limited data indicate that use of neostigmine to treat myasthenia gravis may be acceptable during breastfeeding. This information is based upon LactMed database (available at http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT last accessed 18 March 2011). Due to the potential for serious adverse reactions in nursing infants, manufacturer recommends discontinuation of nursing or discontinuation of drug, taking into account the importance of the drug to the mother.

• CNS: Cholinergic crisis, seizures, dizziness, weakness, syncope, paralysis, headache, paresthesias, fatigue/malaise
• EENT: Lacrimation, miosis, rhinorrhea, blurred vision
• RESP: Bronchospasm, excessive secretions, respiratory depression, respiratory arrest, respiratory paralysis, pulmonary edema
• CV: Bradycardia, severe hypotension, AV block, arrhythmias, hypertension, cardiac arrest
• GI: Abdominal cramps, diarrhea, excessive salivation, nausea, vomiting, flatulence, dyspepsia
• DERM: Rashes, diaphoresis
• GU: Urinary frequency or urgency
• MUSC: Fasciculations, muscle weakness or cramps
• HYPERSENSITIVITY: Anaphylaxis, hypersensitivity reactions

• Cholinergic; inhibits the breakdown of acetylcholine and prolongs its effects
• Poorly absorbed from the GI tract
• Metabolized by liver; plasma (cholinesterases)
• Renally excreted (primarily unchanged)
• Half-life: 52 mins.

US Trade Name(s)

• Prostigmin

US Availability

neostigmine (generic)

• TABS: 15 mg

Prostigmine

• TABS: 15 mg

Canadian Trade Name(s)

• Prostigmine

Canadian Availability

Prostigmine

• TABS: 15 mg

UK Trade Name(s)

• N/A

UK Availability

• N/A

Australian Trade Name(s)

• N/A

Australian Availability

• N/A

[Outline]

Neurologic

Muscle Stimulant

Anticholinesterase