Chemical formula: C₁₂H₁₉N₂O₂⁺ Molecular mass: 223.292 g/mol PubChem compound: 4456
Neostigmine interacts in the following cases:
Neostigmine effectively antagonises the effect of non-depolarizing muscle relaxants (e.g. tubocurarine, gallamine or pancuronium) and this interaction is used to therapeutic advantage to reverse muscle relaxation after surgery.
Atropine antagonises the muscarinic effects of neostigmine, the interaction is utilised to counteract the muscarinic symptoms of the neostigmine toxicity.
Neostigmine should be used with extreme caution in patients with asthma as the parasympathomimetic action of neostigmine may cause bronchoconstriction.
Extreme caution should be employed when treating patients with preexisting bradycardia, cardiac arrhythmia or recent coronary occlusion.
Neostigmine should be used with caution in patients with epilepsy, vagotonia, hyperthyroidism, peptic ulceration or parkinsonism.
The use of neostigmine during pregnancy has not been established. Although the possible hazards to mother and child must be weighed against the potential benefits in every case, experience with Myasthenia Gravis has revealed no untoward effect of the drug on the course of pregnancy. As the severity of Myasthenia Gravis often fluctuates considerably, particular care is required to avoid cholinergic crisis due to overdosage of neostigmine.
The use of neostigmine during 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.
Not applicable.
There is no evidence to suggest that neostigmine bromide has any special effects in the elderly; however, elderly patients may be more susceptible to arrhythmias than the younger adult.
Side-effects and adverse reactions may include nausea and vomiting, increased salivation, diarrhoea and abdominal cramps.
Adverse effects of neostigmine are chiefly those of exaggerated response to parasympathetic stimulation.
| System Organ Class | Adverse reaction | Frequency |
|---|---|---|
| Immune system disorders | Hypersensitivity, angioedema, anaphylactic reaction. | Not known |
| Nervous system disorders | Cholinergic syndrome, especially at high doses. In patients with myasthenia gravis, cholinergic crisis may be difficult to distinguish from myasthenia crisis (see section 4.9). | Not known |
| Eye disorders | Miosis, lacrimation increased | Not known |
| Cardiac disorders | Bradycardia, decreased cardiac conduction, in severe cases possibly leading to heart block or cardiac arrest | Not known |
| Vascular disorders | Hypotension | Not known |
| Respiratory, thoracic or mediastinal disorders | Increased bronchial secretion, bronchospasm | Not known |
| Gastrointestinal disorders | Nausea, vomiting, diarrhoea, abdominal cramps, salivary hypersecretion. Increased intestinal motility may result in involuntary defecation. | Not known |
| Skin and subcutaneous tissue disorders | Hyperhidrosis | Not known |
| Musculoskeletal, connective tissue and bone disorders | Muscle spasms | Not known |
| Renal and urinary disorders | Urinary incontinence | Not known |
© All content on this website, including data entry, data processing, decision support tools, "RxReasoner" logo and graphics, is the intellectual property of RxReasoner and is protected by copyright laws. Unauthorized reproduction or distribution of any part of this content without explicit written permission from RxReasoner is strictly prohibited. Any third-party content used on this site is acknowledged and utilized under fair use principles.
