G-Neostigmine - Injection Neostigmine Methyl Sulphate - 500mcg/ml 1 Injection(s) / Injection Gonoshasthaya Pharmaceuticals Ltd. Introduction: G-Neostigmine is a prescription medicine used in the treatment of myasthenia gravis (a disease causing muscle weakness and tiredness), paralytic ileus (paralysis of intestinal muscles), post-operative urinary retention and reversal of effect of skeletal muscle relaxants after surgery. G-Neostigmine works by reducing and improving muscle weakness. It may be taken with or without food, preferably at the same time each day. Take this medicine in the dose and duration as advised by your doctor. If you have missed a dose, take it as soon as you remember. Do not skip any doses and finish the full course of treatment. You... Uses of G-Neostigmine: Myasthenia gravisParalytic ileusPost-operative urinary retentionReversal of effect of skeletal muscle relaxant after surgery Side effects of G-Neostigmine: NauseaVomitingAbdominal crampDiarrhea How to use G-Neostigmine: Take this medicine in the dose and duration as advised by your doctor. Swallow it as a whole. Do not chew, crush or break it. G-Neostigmine may be taken with or without food, but it is better to take it at a fixed time. How G-Neostigmine works: G-Neostigmine is a reversible cholinesterase inhibitor. When taken by mouth it increases the level of acetylcholine, a chemical messenger in the brain, by suppressing acetylcholinesterase (enzyme). This acetylcholine further triggers muscle contracting receptors which helps in muscle contraction. What if you forget to take G-Neostigmine?: If you miss a dose of G-Neostigmine, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular schedule. Do not double the dose. Indication: Myasthenia gravis, Paralytic ileus, Post-op urinary retention, Reversal of nondepolarising neuromuscular blockade Adult Dose: Parenteral Myasthenia gravis Adult: 0.5-2.5 mg by IM or SC inj, doses are given at intervals according to response up to a total daily dose of 5-20 mg. Paralytic ileus and postoperative urinary retention Adult: 0.5-2.5 mg by SC or IM inj, as required. Reversal of neuromuscular blockade Adult: 0.03-0.07 mg/kg by inj over 60 sec, as required. Not to exceed 0.07 mg/kg or a cumulative total of 5 mg, whichever dose is less Inject by slow IV over at least 1 minute Child Dose: Parenteral Myasthenia gravis Child: <12 yr 0.2-0.5 mg, repeated at suitable intervals throughout the day. Paralytic ileus and postoperative urinary retention Child: 0.125-1 mg by SC or IM inj. Intravenous Reversal of neuromuscular blockade Child: 0.05-0.07 mg/kg by inj over 60 sec, as required. Intramuscular Neonatal myasthenia gravis Child: Initially, 0.1 mg, followed by 0.05-0.25 mg or 0.03 mg/kg 2-4 hrly. Renal Dose: Renal impairment: Dose adjustment may be required. Contraindication: Mechanical GI or urinary tract obstruction, peritonitis. Mode of Action: Neostigmine reversibly inhibits acetylcholinesterase and thus potentiates the nicotinic and muscarinic effects of acetylcholine. This facilitates the transmission of impulses across myoneural junction. Precaution: Patient w/ bronchial asthma, CV disorders (e.g. bradycardia, recent MI, hypotension), peptic ulcer disease, vagotonia, epilepsy, parkinsonism, hyperthyroidism. Patient who underwent recent intestinal or bladder surgery. Renal impairment. Childn. Pregnancy and lactation. Monitoring Parameters Monitor ECG, BP and heart rate esp w/ IV use. Lactation: Unknown if distributed in human breast milk; use caution Side Effect: Allergic: Allergic reactions and anaphylaxis Neurologic: Dizziness, convulsions, loss of consciousness, drowsiness, headache, dysarthria, miosis and visual changes Cardiovascular: Cardiac arrhythmias (including bradycardia, tachycardia, A-V block and nodal rhythm) and nonspecific EKG changes have been reported, as well as cardiac arrest, syncope and hypotension (predominantly with parenteral dosage form) Respiratory: Increased oral, pharyngeal and bronchial secretions, and dyspnea; respiratory depression, respiratory arrest and bronchospasm have been reported following the use of the injectable form Dermatologic: Rash and urticaria Gastrointestinal: Nausea, emesis, flatulence, and increased peristalsis and salivation Genitourinary: Urinary frequency Musculoskeletal: Muscle cramps and spasms, arthralgia Miscellaneous: Diaphoresis, flushing and... Interaction: May reduce effects of anticholinergics. May increase effects of cholinergic agonists. Increased risk of bradycardia with digoxin, diltiazem, verapamil or beta-blockers without intrinsic sympathomimetic activity. Increased muscle weakness and decreased response to anticholinesterases with corticosteroids. May increase effects of depolarising neuromuscular blockers. Effects may be antagonised by drugs with neuromuscular blocking activity e.g. aminoglycosides, clindamycin, colistin, cyclopropane, halogenated inhalational anaesthetics. Effects may be reduced by quinine, chloroquine, hydroxychloroquine, quinidine, procainamide, propafenone, lithium, beta-blockers. Possible additive toxicity with ophthalmic use of anticholinesterases e.g. ecothiopate.