neostigmine

Contraindicated in:

Hypersensitivity;
Mechanical obstruction of the GI or GU tract.

Use Cautiously in:

History of asthma;
Ulcer disease;
Cardiovascular disease;
Seizure disorder;
Hyperthyroidism;
OB: May cause uterine irritability and induce preterm labor when administered near term; use during pregnancy only if potential maternal benefit justifies potential fetal risk;
Lactation: Safety not established in breastfeeding;
Geri: Prolonged duration of effect in older adults due to ↓ in renal function.

Adv. Reactions/Side Effects ⬆ ⬇

CV: bradycardia, hypotension

Derm: sweating, rash

EENT: lacrimation, miosis

GI: abdominal cramps, diarrhea, excess salivation, nausea, vomiting

Neuro: dizziness, SEIZURES, weakness

Resp: bronchospasm, excess secretions

Interactions ⬆ ⬇

Drug-drug:

Action may be antagonized by drugs possessing anticholinergic properties, including antihistamines, antidepressants, atropine, haloperidol, phenothiazines, quinidine, and disopyramide.
Prolongs action of depolarizing muscle-relaxing agents (succinylcholine).

Availability ⬆ ⬇

(Generic available)

Solution for injection: 0.5 mg/mL (vials); 1 mg/mL (vials and prefilled syringes)
In combination with: glycopyrrolate (Prevduo). See Appendix [not included in this PDA edition].

Route/Dosage ⬆ ⬇

IV (Adults and Children ): 0.03 mg/kg for neuromuscular blockers with short half-life (e.g. rocuronium); 0.07 mg/kg for neuromuscular blockers with longer half-life (e.g. vecuronium); dose may be repeated to a total dose of 0.07 mg/kg or 5 mg, whichever is less; pretreat with atropine IV (0.6–1.2 mg for adults; 20 mcg/kg for children).

US Brand Names ⬆ ⬇

Action ⬆ ⬇

Inhibits the breakdown of acetylcholine so that it accumulates and has a prolonged effect.
Effects include miosis, increased intestinal and skeletal muscle tone, bronchial and ureteral constriction, bradycardia, increased salivation, lacrimation, and sweating.

Therapeutic effects:

Reversal of nondepolarizing neuromuscular blockers.

Classifications ⬆ ⬇

Therapeutic Classification: antimyasthenics

Pharmacologic Classification: cholinergics

Pharmacokinetics ⬆ ⬇

Absorption: IV administration results in complete bioavailability.

Distribution: Probably does not cross the placenta or enter breast milk.

Metabolism/Excretion: Metabolized by plasma cholinesterases and the liver.

Half-Life: 24–113 min.

Time/Action Profile ⬆ ⬇

(cholinergic effects, ↑ muscle tone)

ROUTE	ONSET	PEAK	DURATION
IV	10–30 min	20–30 min	2–4 hr

Patient/Family Teaching ⬆ ⬇

Explain purpose of neostigmine to patient.
Rep: Advise female patient to notify health care professional if pregnancy is planned or suspected or if breastfeeding. May cause uterine irritability and induce premature labor when administered to pregnant women near term.

Pronunciation ⬆ ⬇

Code ⬆

NDC Code

43598- Dr.Reddy's Laboratories Inc
- 43598-528- Neostigmine
  - 43598-528-11- 1 VIAL, MULTI-DOSE in 1 CARTON (43598-528-11) > 10 mL in 1 VIAL, MULTI-DOSE

43598- Dr.Reddy's Laboratories Inc
- 43598-528- Neostigmine
  - 43598-528-36- 10 VIAL, MULTI-DOSE in 1 CARTON (43598-528-36) > 10 mL in 1 VIAL, MULTI-DOSE

43598- Dr.Reddy's Laboratories Inc
- 43598-529- Neostigmine
  - 43598-529-11- 1 VIAL, MULTI-DOSE in 1 CARTON (43598-529-11) > 10 mL in 1 VIAL, MULTI-DOSE

43598- Dr.Reddy's Laboratories Inc
- 43598-529- Neostigmine
  - 43598-529-36- 10 VIAL, MULTI-DOSE in 1 CARTON (43598-529-36) > 10 mL in 1 VIAL, MULTI-DOSE

71872- Medical Purchasing Solutions, LLC
- 71872-7178- Neostigmine
  - 71872-7178-1- 1 VIAL, MULTI-DOSE in 1 BAG (71872-7178-1) > 10 mL in 1 VIAL, MULTI-DOSE

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Indications ⬇

Contraind./Precautions ⬆ ⬇