Medicine :   
Neostigmine is a Medicine belongs to Direct acting cholinomimetics group whose properties about Brand can be referenced from   Book : Martindale    Page : 688   Edition : 37,

  ►   Brandname : Prostigmin, Neostig, Robinul-Neostigmine, Neostigmine Min-I-Mix

  ►  Doseform : Tablet with 15  mg, Injection with 0.2  mg/ml, Injection with 0.5  mg, Injection with 1  mg/ml, Injection with 2.5  mg/ml,

Reference of this Medicine for its Strength can be taken from   Book : Basic & Clinical pharmacology    Page : 112   Edition : 12, Basic & Clinical pharmacology    Page : 112   Edition : 37,
A Route of administration in pharmacology and toxicology is the path by which a drug, fluid, poison, or other substance is taken into the body. Routes of administration are generally classified by the location at which the substance is applied. Common examples include oral and intravenous administration.

  ►  Route of administration : Oral, IM, IV, SC, Topical,
Reference :-   Book : Martindale    Page : 688   Edition : 37,

  ►  Indication/uses : Myasthenia Gravis, Reverse neuromuscular blockade, paralytic Ileus, Postoperative Urinary Retention, glaucoma,
Reference :-   Book : Martindale    Page : 688   Edition : 37,
Dosing of Medicine differ in Adult & Pediatrics ↓


► Neostigmine medicine for Adults :

S.No Ailment   Route   Dose Min   Dose Max   Unit   Dosage   Frequency   Additional Info
1 Myasthenia Gravis Oral 75 300 mg Tablet Given in a total daily dose divided throughout the day, and if necessary the night. larger portions of the total dose may be given at times of greater fatigue.
2 Myasthenia Gravis s.c, i.v, i.m 0.5 2.5 mg Injection Giving a total daily dose usually in the range 5 to 20 mg.
3 Reverse neuromuscular blockade IV 50 70 micrograms/kg Injection Dose: Given over a period of 60 seconds.
4 Paralytic Ileus Oral 15 30 mg Tablet
5 Postoperative Urinary Retention Oral 15 30 mg Tablet
6 Paralytic Ileus s.c/ i.m 0.5 2.5 mg Injection
7 Postoperative Urinary Retention s.c/ i.m 0.5 2.5 mg Injection

Ref :-  Book : Martindale    Page : 688   Edition : 37,




For Pediatric :
S.No Ailment   Age Min   Age Max   Weight ( Kg ) Route   Dose Min   Dose Max   Unit   Dosage   Additional Info  
1 Myasthenia Gravis 6Year Oral 7.5 mg Tablet
2 Myasthenia Gravis 6 Year 12 Year Oral 15 mg Tablet
3 Myasthenia Gravis 12Year s.c/ i.m 200 500 micrograms Injection
4 Reverse neuromuscular blockade IV 50 micrograms/kg Injection
5 Paralytic Ileus Oral 2.5 15 mg Tablet
6 Postoperative Urinary Retention Oral 2.5 15 mg Tablet
7 Paralytic Ileus s.c/ i.m 0.125 1 gm Injection
8 Postoperative Urinary Retention s.c/ i.m 0.125 1 mg Injection

Ref :- Book : Martindale    Page : 688   Edition : 37,
►  Side Effect : increased salivation, nausea, vomiting, diarrhoea, abdominal cramp, allergic reaction, excess sweating, Lacrimation, Involuntary Defaecation, Increased Peristalsis, involuntary defaecation and urination or desire to urinate, Miosis, Ciliary Spasm, nystagmus, bradycardia, hypotension, muscle cramp, Fasciculation, weakness, Paralysis, wheezing, increased bronchial secretion combined with bronchoconstriction, ataxia, convulsion, coma, slurred speech, Restlessness, agitation, fear, Tight chest, Death may result from respiratory failure, due to a combination of the muscarinic, nicotinic, and central effects, or cardiac arrest,
Ref :-   Book : Martindale    Page : 687   Edition : 37,

►  Interaction : Atropine , , Suxamethonium/Succinylcholinechloride (Suxamethonium chloride) , , , Propafenone, Procainamide , Hydroxychloroquine , Chloroquine , Quinidine , , , Colistin, Clindamycin , ,
Ref :-   Book : Martindale    Page : 687   Edition : 37,


►  Contraindication : Mechanical gastrointestinal or urinary-tract obstruction, Peritonitis, It should be used with extreme caution in patients who have undergone recent intestinal or bladder surgery and in patients with bronchial asthma, It should be used with caution in patients with cardiovascular disorders including arrhythmias, bradycardia, recent myocardial infarction, and hypotension, as well as in patients with vagotonia, epilepsy, hyperthyroidism, parkinsonism, renal impairment, or peptic ulcer disease., When neostigmine is given by injection, atropine should always be available to counteract any excessive muscarinic reactions,
Ref :-   Book : Martindale    Page : 687   Edition : 37,
  ►    Mechanism of Drug Drug Interaction :  Drugs with neuromuscular blocking activity, such as the aminoglycosides, clindamycin, colistin, cyclopropane, and the halogenated inhalational anaesthetics, may antagonise the effects of neostigmine. Those such as quinine, chloroquine, hydroxychloroquine, quinidine, procainamide, propafenone, lithium, and the beta blockers, that have the potential to aggravate myasthenia gravis, can reduce the effectiveness of treatment with parasympathomimetics. Prolonged bradycardia has also occurred in patients receiving beta blockers when given neostigmine. Anticholinesterases, such as neostigmine, can inhibit the metabolism of suxamethonium and enhance and prolong its action; combined use is not recommended. Ophthalmic use of anticholinesterases, such as ecothiopate, should be undertaken with care in patients receiving neostigmine systemically for myasthenia gravis, because of possible additive toxicity. Antimuscarinics such as atropine antagonise the muscarinic effects of neostigmine.,
Ref :-   Book : Martindale    Page : 687   Edition : 37,


  ►  Mechanism of Action :   Neostigmine is a quaternary ammonium compound that inhibits cholinesterase activity and thus prolongs and intensifies the physiological actions of acetylcholine . It probably also has direct effects on skeletal muscle fibres. The anticholinesterase actions of neostigmine are reversible.,
Ref :-   Book : Martindale    Page : 687   Edition : 37,
 ►   

Dietary Products that produce same effect as  Neostigmine






►   Route of Elimination :   Hepatic (Metabolism), Renal,
Ref :-   Book : Martindale    Page : 687   Edition : 37,


►    Plasma Half-life :   Min value :-   0.87 hours,    Max value :-   NA
Ref :-   Book : Martindale    Page : 687   Edition : 37,


►    Peak Plasma Concentration :   Min value :-   1 hours,    Max value :-   2 hours,
Ref :-   Book : Martindale    Page : 687   Edition : 37,