Neostigmine

Administration

• Type: Cholinesterase inhibitor
• Dosage Forms:
• Routes of Administration: IV, oral (not FDA-approved)
• Common Trade Names:

Adult Dosing

• Reversal of non-depolarizing neuromuscular blocking agents:
  • Initial: 0.03-0.07 mg/kg IV, if no efffect, repeat q1 min up to max total dose of 0.07mg/kg or 5mg
• Myasthenia gravis: 15-375mg PO daily (Not FDA-approved)

Pediatric Dosing

• Safety/efficacy not well-established in peds, but generally same weight-based dosing as adults

Special Populations

• Pregnancy Rating: C, Fetal risk cannot be ruled out
• Lactation risk: Avoid breastfeeding
• Renal dosing: no adjustment
• Hepatic dosing: no adjustment

Contraindications

• Allergy to class/drug
• Mechanical bowel or urinary tract obstruction
• Peritonitis

Adverse Reactions

Serious

• Bradyarrythmia, Atrioventricular block
• Seizure, loss of conciousness

Common

• Hypotension
• Nausea, vomiting

Pharmacology

• Half-life: 40-75 min
• Metabolism: Hepatic (extensive)
• Excretion: Renal

Mechanism of Action

• Competitive cholinesterase inhibitor→ less breakdown of acetylcholine→ more acetylcholine in synapses

See Also

• Neuromuscular blocking agents
• Myasthenia gravis
• Pyridostigmine