Neostigmine

Neostigmine Brands

Brand Name	Manufacturer Name	Distributor	Drug Strength	Packaging	Formulation	Formulation Strength	Price
Myostigmin	Neon Laboratories Ltd	Sai Pharmaceuticals Ltd.	0.5mg	10ml	Injection	per vial	KES 296.00
Myostigmin	Neon Laboratories Ltd	Sai Pharmaceuticals Ltd.	2.5mg	25ml	Injection	per vial	KES 330.00
Myostigmin	Neon Laboratories Ltd	Sai Pharmaceuticals Ltd.	2.5mg	10ml	Injection	per vial	KES 500.00
Neostigmine	Fresenius kabi (formally Dabur Pharmaceuticals)	Universal Corporation Ltd	2.5mg	10	Injection	per vial	KES 840.00
Tilstigmin	Tablets India Ltd.	Harley's Limited	2.5mg	10	Tablet	per tablet	KES 400.00

Neostigmine More info
Mode Of Action	Anti-cholinesterases: inhibit the hydrolysis of acetylcholine by competing with it for attachment to acetylcholinesterase at sites of cholinergic transmission
Drug Indication	Myasthenia gravis, paroxysmal tachycardia, migraine and intestinal and post-operative atony, termination of effects of neuromuscular blocking agent
Precautions	Bronchial asthma, cardiac rhythm disturbances, hypotension, epilepsy, peptic ulcers, Parkinsonism, elderly, impaired renal function. Aminoglycosides use as they accentuate neuromuscular blockage.
Contra-Indications	Pregnancy and lactation, concomitant use with depolarising muscle relaxants, during halothane/cyclopropane anaesthesia, diabetes, gangrene
Side Effects	GI disturbances, muscle cramps, increased salivation, headache, miosis, increased bronchial secretions, sweating, involuntary defaecation and micturition, nystagmus, hypotension, bradycardia.
Pregnancy Category	Category B2
Pregnancy Category Description	Drugs which have been taken by only a small number of pregnant women and women of child-bearing age with no any established rise in the frequency of malformations or other direct or indirect detrimental effects on the foetus having been noted. Studies in animals are inadequate or lacking but available data show no evi-dence of an increased occurrence of foetal damage. Studies in animals are inadequate or lacking but available data show no evi-dence of an increased occurrence of foetal damage.
Drug Category	DRUGS ACTING ON CNS
Drug Sub-Category	Anticholinesterases Dosing: Adult Myasthenia gravis, diagnosis: I.M.: 0.02 mg/kg as a single dose; Note: In the diagnosis of myasthenia gravis, all anticholinesterase medications should be discontinued for at least 8 hours before administering neostigmine. Myasthenia gravis, treatment: Oral: 15 mg/dose every 3-4 hours up to 375 mg/day maximum; interval between doses must be individualized to maximal response I.M., I.V., SubQ: 0.5-2.5 mg every 1-3 hours up to 10 mg/24 hours maximum Reversal of nondepolarizing neuromuscular blockade after surgery in conjunction with atropine: I.V.: 0.5-2.5 mg; total dose not to exceed 5 mg; must administer atropine several minutes prior to neostigmine Bladder atony: I.M., SubQ: Prevention: 0.25 mg every 4-6 hours for 2-3 days Treatment: 0.5-1 mg every 3 hours for 5 doses after bladder has emptied Dosing: Pediatric Myasthenia gravis, diagnosis: I.M.: Children: 0.04 mg/kg as a single dose; Note: In the diagnosis of myasthenia gravis, all anticholinesterase medications should be discontinued for at least 8 hours before administering neostigmine. Myasthenia gravis, treatment: Children: Oral: 2 mg/kg/day divided every 3-4 hours I.M., I.V., SubQ: 0.01-0.04 mg/kg every 2-4 hours Reversal of nondepolarizing neuromuscular blockade after surgery in conjunction with atropine (must administer atropine several minutes prior to neostigmine): I.V.: Infants: 0.025-0.1 mg/kg/dose Children: 0.025-0.08 mg/kg/dose Dosing: Geriatric Refer to adult dosing. Dosing: Renal Impairment Clcr 10-50 mL/minute: Administer 50% of normal dose. Clcr <10 mL/minute: Administer 25% of normal dose