How it works?
Uses of Neostigmine Methylsulphate Injection
Neostigmine Methylsulphate Injection helps muscles work better by stopping an enzyme that breaks down a chemical called acetylcholine. This chemical tells your muscles when to move. By keeping more acetylcholine around, neostigmine helps reverse muscle weakness caused by certain medications used during surgery.
What Neostigmine Methylsulphate Injection Used For
| Use | What It Helps With |
|---|---|
| Reversing muscle relaxants after surgery | Helps you regain normal muscle movement |
| Treating myasthenia gravis | A condition that causes muscle weakness |
| Helping with trouble urinating after surgery | Makes it easier to pass urine |
| Treating slow gut movement (paralytic ileus) | Helps restart bowel movement |
| Rare cases of swollen large intestine (Ogilvie’s syndrome) | Improves gut function |
Precautions of Neostigmine Methylsulphate Injection
Precautions of Neostigmine Methylsulphate Injection:
Risk of Bradycardia
The heart rate may be slowed with neostigmine.
To lower this risk, atropine sulfate or glycopyrrolate pretreatment is advised.
Heart-Related Disorders
Use with caution in patients who have:
Heart disease
Arrhythmias of the heart
Acute coronary syndrome recent
Gravis myasthenia
These patients might be more susceptible to dysrhythmia, bradycardia, or hypotension.
Anticholinergic medications can assist in controlling these side effects.
Intolerance
There could be allergic reactions, including anaphylaxis.
Keep emergency drugs and atropine close at hand.
Neuromuscular Impairment
When muscle recovery is almost finished, high dosages may result in dysfunction.
Adapt the dosage to the neuromuscular condition.
Myasthenic Crisis vs. Cholinergic Crisis
Although they both result in extreme muscle weakness, they need different therapies.
To prevent symptoms from getting worse, an accurate diagnosis is essential.
Considerations for Pregnancy and Lactation
Being pregnant
There is no available well-controlled human research.
Low dosages cause no harm, according to animal research.
may result in near-term preterm labor or uterine irritation.
Use only when absolutely necessary.
If a medication enters breast milk during lactation, it is unknown.
Think about
Benefits of breastfeeding
The necessity of treatment for Mom
possible dangers to the baby.
Dosages administration of Neostigmine Methylsulphate Injection
Dosages Of Neostigmine Methylsulphate Injection
- Only medical professionals with the necessary training should administer it.
- To determine the best time and dose, use a peripheral nerve stimulator.
- Give intravenously over a period of not less than one minute.
- Until you fully recover, make sure your nostrils are open and that you have enough ventilation.
Adult Dosage Guidelines for
| Parameter | Recommendation |
|---|---|
| TOF Monitoring | Required: first twitch 10% of baseline |
| Dose Range | 0.03–0.07 mg/kg IV |
| Injection Rate | Slow IV over ≥1 minute |
| Max Total Dose | 0.07 mg/kg or 5 mg, whichever is less |
| TOF Recovery Target | TOF ratio of 0.9 within 10–20 minutes |
Dose Selection Criteria
- 0.03 mg/kg:
- For short-acting NMBAs (e.g., rocuronium)
- When the TOF response is strong or a second twitch is present.
- 0.07 mg/kg:
- For long-acting NMBAs (e.g., vecuronium, pancuronium)
When TOF response is weak or rapid reversal is needed.
Pediatric Dosage
- Follow adult dosing guidelines
Pediatric patients require similar weight-based doses
| Agent | Timing | Route |
|---|---|---|
| Atropine sulfate or Glycopyrrolate | Prior to or with Neostigmine | IV via separate syringe |
- In bradycardia, administer anticholinergic first.
Monitoring & Recovery
- Continue TOF monitoring post-dose.
- Do not rely solely on TOF for extubation decisions.
- Assess:
- Skeletal muscle tone.
- Respiratory function.
- Patient’s clinical condition.
Side effects of Neostigmine Methylsulphate Injection
Side Effect of Neostigmine Methylsulphate Injection.
Nervous System
- Convulsions, drowsiness, slurred speech (dysarthria)
- Muscle twitching (fasciculation), loss of consciousness
- Pupil constriction (miosis), visual disturbances
Cardiovascular
- Cardiac arrest, arrhythmias (A-V block, nodal rhythm)
- Low blood pressure (hypotension), fainting (syncope)
- Nonspecific EKG changes
Respiratory
- Bronchospasm, increased secretions (oral, pharyngeal, bronchial)
- Respiratory depression or arrest
Allergic Reactions
- Rash, hives (urticaria), anaphylaxis
Gastrointestinal
- Cramps, diarrhea, gas (flatulence), increased bowel movement
Miscellaneous
- Sweating (diaphoresis), flushing
Musculoskeletal
- Joint pain (arthralgia), cramps, spasms, weakness
Urinary
- Increased frequency
These effects stem from neostigmine’s role as a cholinesterase inhibitor, which boosts acetylcholine levels—great for reversing muscle relaxants, but it also ramps up parasympathetic activity, hence the wide-ranging side effects.
Storage instruction of Neostigmine Methylsulphate Injection
Store at a temperature not exceeding 25°C. Protect from light.
Keep out of reach of children.
Packing details of Neostigmine Methylsulphate Injection
10 × 1 ml Ampoules
Neostigmine Methylsulphate Injection is available as 1 ml in an amber blue dot glass ampoule. Such 10 glass ampoules in a unit carton with a pack insert.
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