ADMINISTRATION ROUTES: IV
ALTERNATIVE NAMES: Neostigmine
ICU INDICATIONS: 1. Reversalofneuromuscularblockade 2. Ileus
PRESENTATION AND ADMINISTRATION:
2.5mg in 1ml vial For reversal of neuromuscular blockade administer with either atropine or glycopyrrolate For ileus, add 2.5mg to 100ml of compatible IV fluid and administer over 5 hours Compatible with the following IV fluids: Normal saline 5% dextrose Store at room temperature
For reversal of neuromuscular blockade, use 2.5mg of neostigmine with 0.6-1.2mg of atropine For treatment of ileus give 2.5mg neostigmine over no less than 5 hours (see PRESENTATION AND ADMINISTRATION)
DOSAGE IN RENAL FAILURE AND RENAL REPLACEMENT THERAPY:
Dose as in normal renal function
DOSAGE IN PAEDIATRICS:
For reversal of neuromuscular blockade, add 1.25mg (0.5ml) of neostigmine + 0.3mg (0.5ml) of atropine + 0.5ml of normal saline and then give 0.1ml/kg IV Note: do not use as a treatment for ileus in children due to high risk of symptomatic bradycardia or asysole
CLINICAL PHARMACOLOGY: Neostigmine inhibits the hydrolysis of acetylcholine by competing with acetylcholine for attachment to acetylcholinesterase at sites of cholinergic transmission. It enhances cholinergic action by facilitating the transmission of impulses across neuromuscular junctions.
CONTRAINDICATIONS: 1. hypersensitivitytoneostigmine 2. mechanicalobstructionofthegastrointestinaltract
WARNINGS Neostigmine can cause severe bradycardia and even asystole
Neostigmine methylsulfate should be used with caution in patients with epilepsy, bronchial asthma, bradycardia, recent coronary occlusion, vagotonia, hyperthyroidism, cardiac arrhythmias or peptic ulcer.
No tests in addition to usual ICU tests are indicated
Drug/Laboratory Test Interactions:
None of note
IMPORTANT DRUG INTERACTIONS FOR THE ICU Neostigmine methylsulfate does not antagonize, and may in fact prolong, the Phase I block of depolarizing muscle relaxants such as succinylcholine.
Body as a Whole
Dizziness, convulsions, loss of consciousness, drowsiness, headache, dysarthria, miosis and visual changes. Cardiovascular: Cardiac arrhythmias (including bradycardia, tachycardia, A-V block and nodal rhythm), cardiac arrest, syncope and hypotension.
Increased oral, pharyngeal and bronchial secretions, dyspnea, respiratory depression, respiratory arrest and bronchospasm. Dermatologic: Rash and urticaria.
Nausea, salivation, cramp, emesis, diarrhoea, flatulence and increased peristalsis.
Muscle cramps and spasms, arthralgia.
Diaphoresis, flushing and weakness.