Composition:
Each 1ml solution contains 2.5mg Neostigmine Methylsulfat.
Mechanism of action:
Neostigmine inhibits cholinesterase activity and prolongs and intensifies the muscarinic and nicotinic effects of acetylcholine.
The anti-cholinesterase actions of Neostigmine are reversible. It is used mainly for its action on skeletal muscle
and less frequently to increase the activity of smooth muscle.
Indications:
- Myasthenia Gravis.
- Antagonist to non-depolarizing neuromuscular blockade.
- Paralytic Ileus.
- Post-operative Urinary Retention.
- Paroxysmal Supraventricular Tachycardia.
Contraindications:
1- Hypersensitivity to neostigmine or to any of the excipients.
2- Patients with mechanical obstruction of gastrointestinal or urinary tracts, peritonitis or doubtful bowel viability.
3-Neostigmine should not be used in conjunction with depolarising muscle relaxants such as suxamethonium as
neuromuscular blockade may be potentiated.
warnings and precautions:
Side effects:
Adverse effects of Neostigmine are chiefly those of exaggerated response to parasympathetic stimulation: hypersensitivity, angioedema, anaphylactic reaction, cholinergic syndrome, lacrimation increased, bradycardia, decreased cardiac conduction, hypotension, increased bronchial secretion, nausea, vomiting, diarrhea, abdominal cramps,
salivary hypersecretion. hyperhidrosis, muscle spasms and urinary incontinence.
Drug Interactions:
Dosage and administration:
Myasthenia Gravis:
1 – 2.5mg by IM or SC injection at intervals throughout the day, when maximum strength is needed.
The usual duration of action of a dose is two to four hours.
The total daily dose is usually 5 – 20mg by injection but higher doses may be needed by some patients.
Older Children (Under 12 years of age: May be given 0.2 – 0.5mg by injection as required. Dosage requirements should be adjusted according to the response of the patient.
Antagonist to Non-depolarizing Neuromuscular Blockade: Reversal of Neuromuscular blockade
with Neostigmine should not be attempted unless there is spontaneous recovery from paralysis.
Adults and Children:
Other Indications:
Adults: 0.5 – 2.5mg Neostigmine Methylsulfate by SC or IM injection.
Children: 0.125 – 1mg by injection. Doses may be varied according to the individual needs of the patient.
Elderly: There is no specific dosage.
Overdose:
Symptoms: Cholinergic Crisis, which is characterised by nausea, vomiting, diarrhoea, excessive salivation and sweating, increased bronchial secretions, bradycardia or tachycardia, cardiospasm, bronchospasm, muscle cramps.
Extremely high doses may produce CNS symptoms of agitation, fear or restlessness.
Death may result from cardiac arrest or respiratory paralysis and pulmonary oedema.
Treatment: Maintenance of adequate respiration is of primary importance. Respiration can be assisted mechanically or with oxygen, if necessary.
Stidan should be discontinued immediately and 1 – 4mg of Atropine Sulfate administered IV. Additional doses of Atropine may be given every 5 – 30 minutes as needed to control muscarinic symptoms.
Pregnancy & Lactation:
The use of Stidan during pregnancy or lactation has not been established.
Only negligible amounts of Neostigmine are excreted in breast milk. Nevertheless, attention should be paid to possible effects on the breast-feeding infant.