Neostigmine Injection

## Composition and Pharmacology

– **Neostigmine Injection** is available in concentrations of **0.5 mg/ml** and **2.5 mg/ml**  .

– Each ml contains **Neostigmine Methylsulfate** and **Water for Injection**  .

– It is classified as an **anticholinesterase** (ATC code: N07AA01) and inhibits cholinesterase activity, enhancing the effects of **acetylcholine**  .

– Primarily used for **Myasthenia Gravis**, it also affects skeletal and smooth muscle  .

## Indications and Contraindications

– **Indications** include Myasthenia Gravis, reversal of non-depolarizing neuromuscular blockade, paralytic ileus, post-operative urinary retention, and paroxysmal supraventricular tachycardia  .

– **Contraindications** include hypersensitivity to Neostigmine, mechanical obstruction of gastrointestinal or urinary tracts, and concurrent use with depolarizing muscle relaxants  .

## Drug Interactions

– Neostigmine antagonizes non-depolarizing muscle relaxants, aiding in reversing muscle relaxation post-surgery  .

– **Atropine** is used to counteract muscarinic effects of Neostigmine  .

– Caution is advised when using aminoglycoside antibiotics in patients with Myasthenia Gravis  .

## Warnings and Precautions

– Use with caution in patients with **asthma**, **bradycardia**, or **cardiac arrhythmias**  .

– **Atropine** should be available to manage severe cholinergic reactions  .

– Elderly patients may be more susceptible to dysrhythmias  .

## Side Effects

– Common adverse effects include **nausea**, **vomiting**, **diarrhea**, **bradycardia**, and **increased bronchial secretions**      .

– Severe reactions may include **cholinergic crisis**, which can be difficult to distinguish from myasthenic crisis  .

## Overdose Management

– Symptoms of overdose include cholinergic crisis features such as excessive salivation, bronchospasm, and potential respiratory failure  .

– Treatment involves maintaining respiration and administering **Atropine**  .

## Dosage and Administration

– Recommended doses vary by indication and patient age, with specific guidelines for adults, children, and neonates     .

– Neostigmine can be administered via **IV**, **IM**, or **SC injection**, with careful monitoring   .

## Pregnancy and Lactation

– The safety of Neostigmine during pregnancy and lactation is not fully established, but it has shown no adverse effects on pregnancy in Myasthenia Gravis patients   .

## Storage and Presentation

– Store Neostigmine protected from light at temperatures below **25°C**  .

– Available in packs of **5x1ml ampoules**  .