Neostigmine - Benefits, dosage and side effects

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Neostigmine - Benefits, dosage and side effects
Neostigmine - Benefits, dosage and side effects
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Neostigmine is a drug to relieve the symptoms of myasthenia gravis. In addition, this drug is also used in the treatment of postoperative paralytic ileus or urinary retention, and helps to relieve the effects of postoperative anesthetics

Myasthenia gravis is muscle weakness in the body due to disorders of the nerves and muscles. In this condition, the immune system produces antibodies that destroy acetylcholine, a chemical that plays an important role in conveying signals from nerve cells to muscles.

Neostigmine - ALODOKTER

Neostigmine works by slowing down the breakdown of acetylcholine (acetylcholine). With reduced breakdown of acetylcholine, the symptoms of muscle weakness in the body can subside.

This drug can also interfere with the action of neuromuscular blocking agents, so it can be used to help relieve the effects of postoperative anesthetics.

Neostigmine trademark: Neostigmine-Hameln, Neostigmine Methylsulfate, Tyzox

What is Neostigmine

Class Prescription drugs
Categories cholinesterase inhibitors
Benefits Relieve the symptoms of myasthenia gravis, paralytic ileus, or postoperative urinary retention, and eliminate the effects of postoperative anesthesia.
Used by Adults and children
Neostigmine for Pregnant and Breastfeeding Mothers Category C: Animal studies have shown adverse effects on the fetus, but there are no controlled studies in pregnant women. Drugs should only be used if the expected benefit outweighs the risk. to the fetus.

Neostigmine can be absorbed into breast milk. If you are breastfeeding, do not use this medicine without consulting your doctor.

Medicine Form Injections and tablets

Warning Before Using Neostigmine

Here are some things you need to pay attention to before using neostigmine:

  • Tell your doctor about any allergies you have. Neostigmine should not be used by patients who are allergic to this drug.
  • Tell your doctor if you have peritonitis, obstruction of the urinary tract, or obstruction of the digestive tract, including intestinal obstruction. Neostigmine should not be used by patients with this condition.
  • Tell your doctor if you have ever had coronary heart disease, a heart rhythm disorder, or a heart attack.
  • Tell your doctor if you have asthma, Parkinson's disease, hypotension, epilepsy, peptic ulcers, kidney disease, or hyperthyroidism
  • Tell your doctor if you have recently had bowel or bladder surgery.
  • Tell your doctor if you are taking any other medicines, including supplements or herbal products.
  • Tell your doctor that you are being treated with neostigmine before undergoing certain medical procedures or surgery.
  • Tell your doctor if you are pregnant, breastfeeding, or planning a pregnancy.
  • See your doctor immediately if you have an allergic reaction, serious side effects, or overdose, after using neostigmine.

Dosage and Instructions for Use of Neostigmine

The dose of neostigmine given by the doctor will be adjusted to the condition being treated, the age of the patient, and the form of the drug. Below is a breakdown of common neostigmine dosages:

Condition: Myasthenia gravis

Medication form: Neostigmine bromide tablets

  • Adults: 15–30 mg, the dose is given at intervals adjusted to the body's response to the drug. Total daily dose 75–300 mg.
  • Children aged 6–12 years: 15 mg, the dose may change depending on the body's response to the drug. The total daily dose is 15–90 mg.
  • Children aged <6 years: 7.5 mg.

Form of medicine: Injection

This form of the drug contains neostigmine methylsulfate which will be injected under the skin (subcutaneously/SC) or into a muscle (intramuscular/IM)

  • Adults: 0.5-2.5 mg, the dose is given at intervals adjusted to the body's response to the drug. Total daily dose 5–20 mg.
  • Children aged <12 years: 0, 2–0, 5 mg, the dose will be repeated according to the patient's condition.

Condition: Eliminates the effects of postoperative anesthesia (neuromuscular blockade)

Form of medicine: Injection

This form of medicine contains neostigmine methylsulfate which will be injected into a vein (intravenous/IV)

  • Adults and children: 0.05–0.07 mg/kgBW injected for 60 seconds or more.

Condition: Paralytic ileus or urinary retention after surgery

Medication form: Neostigmine bromide tablets

  • Adult: 15–30 mg. The dose and frequency of administration will be adjusted according to the patient's response.
  • Children: 2, 5–15 mg. The dose and frequency of administration will be adjusted according to the patient's response.

Form of medicine: Injection

This form of the drug contains neostigmine methylsulfate which will be injected into the muscle (intramuscularly/IM) or under the skin (subcutaneously/SC)

  • Adult: 0, 5–2, 5 mg
  • Children: 0, 125–1 mg

How to Use Neostigmine Correctly

Neostigmine in injectable form will be given by a doctor or medical officer under the supervision of a doctor. Drug injection can be done IM/IV/SC. Always follow the doctor's advice during treatment with this drug.

While you are undergoing treatment with injectable neostigmine, your doctor will monitor your blood pressure, oxygen levels, kidney function, and other vital signs. The doctor will also check your reflexes to make sure that neostigmine is effective in reversing the effects of the anesthetic.

Neostigmine in tablet form needs to be consumed according to the doctor's instructions or the rules on the packaging. Do not reduce or increase the dose taken without a doctor's instructions. This medicine can be taken with or without food. Take the tablet with a glass of water.

If you forget to take a neostigmine tablet, take it immediately if the time lag with the next dose is not too close. If the time lag is too close, ignore the dose and do not double the next dose.

Make sure to have regular check-ups with the doctor according to the schedule, so that the effectiveness of the drug is monitored. Store neostigmine tablets in a dry and cool place away from direct sunlight. Keep this medicine out of reach of children.

Neostigmine Interaction with Other Drugs

Drug interaction effects that can occur if neostigmine is used with certain drugs include:

  • Reduced muscarinic effect of neostigmine when used with atropine
  • Decreased therapeutic effect of neostigmine when used with chloroquine, quinine, hydroxychloroquine, quinidine, procainamide, propafenone, or lithium
  • Increased risk of loss of the therapeutic effect of neostigmine when used with aminoglycoside drugs, clindamycin, colistin, cyclopropane, or halogen anesthetics
  • Increased risk of prolonged apnea or prolonged respiratory arrest after surgery when used with muscle relaxants, such as suxamethonium
  • Increased risk of prolonged slow heart rate (bradycardia) when used with beta blockers

Side Effects and Dangers of Neostigmine

There are several side effects that can occur after using neostigmine, namely:

  • Excess saliva production
  • Nausea or vomiting
  • Pupil size reduction
  • Cold
  • watery eyes
  • Excessive sweat
  • Slow heart rate
  • stomach cramps
  • irregular heartbeat
  • Low blood pressure
  • Urination becomes more frequent
  • Diarrhea
  • The urge to urinate suddenly appears
  • Not feeling well
  • Headache or vertigo
  • Twitch muscles
  • Fainted

Tell your doctor if the above side effects do not improve or get worse. See a doctor immediately if you have an allergic reaction to the drug or serious side effects, such as:

  • Slow heart rate
  • irregular heartbeat
  • Low blood pressure
  • Fainted

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