Neostigmine Methylsulfate

Generic Name: Neostigmine Methylsulfate
Brand Name: IPOSTIGMINE®
Dosage Form: Injection 0.5mg/1ml - Injection2.5mg/1ml
Pharmacological Category: Parasympathomimetic (Cholinergic) Agents
Therapeutic Category: Antimyasthenic,Muscle Relaxant
Pregnancy Category: category C

Pharmacology

Facilitates myoneural junction impulse transmission by inhibiting acetylcholine destruction by cholinesterase.

Pharmacokinetics:

Rapid absorption, protein binding is 15% to 25% (serum albumin). Neostigmine is metabolized in the liver by microsomal enzymes and undergoes hydrolysis by cholinesterase. It`s is eliminated in urine (50% as unchanged). Half-life is 51 to 90 min and plasma half-life is 47 to 60 min (IV).

Indications:

Symptomatic control of myasthenia gravis; antidote for nondepolarizing neuromuscular blocking agents after surgery; prevention and treatment of postoperative distention and urinary retention (IV only).

Contraindications:

Hypersensitivity to anticholinesterases and bromides; mechanical intestinal or urinary obstruction; peritonitis

Precautions:

• For IV, subcutaneous, or IM administration. Not for intradermal or intra-arterial administration.
• Do not administer if particulate matter or discoloration is noted.
• Patients on IV neostigmine can be transferred to the oral form as soon as it can be tolerated.
• Tablets
• Administer as prescribed. Size of dose (eg, number of tablets) and frequency of administration will be adjusted to provide max relief of myasthenia gravis symptoms.
• Administer without regard to meals. Administer with food if GI upset occurs.
• Larger portions of the daily dose may be given at times when the patient is more prone to fatigue (eg, afternoons, mealtimes).
• Large doses should be avoided in situations where there might be an increased absorption rate from the intestinal tract.
• Ensure that parenteral atropine is available for emergency treatment of cholinergic crisis.

Drug Interactions:

• Anticholinergic agents (eg, atropine, belladonna)
Intestinal motility may be slowed, increasing neostigmine absorption. Use with caution. Adjust the neostigmine dose as needed.

• Beta-blockers (eg, propranolol)
Severe or prolonged bradycardia may occur because of additive pharmacologic effects. Use with caution. Larger dosages of atropine and sympathomimetic pressor agents may be needed to reverse bradycardia and hypotension.

• Corticosteroids (eg, corticotropin, hydrocortisone)
The effects of neostigmine may be decreased. In addition, the effects of neostigmine may be increased after corticosteroids are discontinued. Provide mechanical respiratory support if needed.

• Drugs that interfere with neuromuscular transmission
May interfere with neuromuscular transmission. Use with caution in myasthenic patients. Monitor the patient and increase the neostigmine dose as needed.

• Kanamycin, streptomycin
Neuromuscular blockade may be enhanced. Use these antibiotics in myasthenic patients only when clearly indicated. Closely monitor the patient. Adjust the neostigmine dose as needed.

• Local/General anesthetics, antiarrhythmic agents (eg, procainamide)
Use with caution in myasthenic patients; may interfere with neuromuscular transmission. Increase the neostigmine dose as needed.

• Quinine
Quinine may antagonize the effects of neostigmine. Avoid using quinine in patients receiving neostigmine for myasthenia gravis.

• Succinylcholine
Neuromuscular blockade produced by succinylcholine may be prolonged. Avoid this combination in the presence of a depolarizing (phase 1) type of neuromuscular blockade. Use with caution if a nondepolarizing (phase 2) type of blockade is present. Provide mechanical respiratory support as needed.

Side Effects:

Cardiovascular:
Common (1% to 10%): Bradycardia, hypotension, tachycardia
Frequency not reported: Nonspecific EKG changes, cardiac arrest, syncope
Postmarketing reports: Cardiac arrhythmias (A-V block, nodal rhythm)

Dermatologic:
Common (1% to 10%): Pruritus
Frequency not reported: Rash, urticaria

Gastrointestinal:
Common (1% to 10%): Dry mouth, nausea (including post-procedural), vomiting
Frequency not reported: Flatulence, increased peristalsis
Postmarketing reports: Bowel cramps, diarrhea

Genitourinary:
Frequency not reported: Urinary frequency

Hypersensitivity:
Frequency not reported: Allergic reactions and anaphylaxis

Musculoskeletal:
Frequency not reported: Muscle cramps and spasms, arthralgia
Postmarketing reports: Muscle weakness

Nervous system:
Common (1% to 10%): Dizziness, headache, postoperative shivering, prolonged neuromuscular blockade, insomnia
Postmarketing reports: Convulsions, drowsiness, dysarthria, fasciculation, loss of consciousness

Ocular:
Frequency not reported: Miosis, visual changes

Other:
Common (1% to 10%): Incision site complication, procedural complication and pain
Frequency not reported: Diaphoresis, flushing, weakness

Renal:
Postmarketing reports: Urinary frequency

Respiratory:
Common (1% to 10%): Pharyngolaryngeal pain, dyspnea, oxygen desaturation (less than 90%)
Frequency not reported: Increased oral, pharyngeal and bronchial secretions, dyspnea, respiratory depression, respiratory arrest, bronchospasm

Storage:

• Store below 30 C°
• Protect from light and freezing

Packing:

• Injection 0.5mg/1ml: Box of 10 Ampoules
• Injection 2.5mg/1ml: Box of 10 Ampoules

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Image: 
Brand Name: 

IPOSTIGMINE®

Dosage Form: 

Injection 0.5mg/1ml - Injection2.5mg/1ml

Pharmacological Category: 

Parasympathomimetic (Cholinergic) Agents

Therapeutic Category: 

Antimyasthenic,Muscle Relaxant

Pregnancy Category: 

category C

Facilitates myoneural junction impulse transmission by inhibiting acetylcholine destruction by cholinesterase.

Pharmacokinetics: 

Rapid absorption, protein binding is 15% to 25% (serum albumin). Neostigmine is metabolized in the liver by microsomal enzymes and undergoes hydrolysis by cholinesterase. It`s is eliminated in urine (50% as unchanged). Half-life is 51 to 90 min and plasma half-life is 47 to 60 min (IV).

Indications: 

Symptomatic control of myasthenia gravis; antidote for nondepolarizing neuromuscular blocking agents after surgery; prevention and treatment of postoperative distention and urinary retention (IV only).

Contraindications: 

Hypersensitivity to anticholinesterases and bromides; mechanical intestinal or urinary obstruction; peritonitis

Precautions: 

• For IV, subcutaneous, or IM administration. Not for intradermal or intra-arterial administration.
• Do not administer if particulate matter or discoloration is noted.
• Patients on IV neostigmine can be transferred to the oral form as soon as it can be tolerated.
• Tablets
• Administer as prescribed. Size of dose (eg, number of tablets) and frequency of administration will be adjusted to provide max relief of myasthenia gravis symptoms.
• Administer without regard to meals. Administer with food if GI upset occurs.
• Larger portions of the daily dose may be given at times when the patient is more prone to fatigue (eg, afternoons, mealtimes).
• Large doses should be avoided in situations where there might be an increased absorption rate from the intestinal tract.
• Ensure that parenteral atropine is available for emergency treatment of cholinergic crisis.

Drug Interactions: 

• Anticholinergic agents (eg, atropine, belladonna)
Intestinal motility may be slowed, increasing neostigmine absorption. Use with caution. Adjust the neostigmine dose as needed.

• Beta-blockers (eg, propranolol)
Severe or prolonged bradycardia may occur because of additive pharmacologic effects. Use with caution. Larger dosages of atropine and sympathomimetic pressor agents may be needed to reverse bradycardia and hypotension.

• Corticosteroids (eg, corticotropin, hydrocortisone)
The effects of neostigmine may be decreased. In addition, the effects of neostigmine may be increased after corticosteroids are discontinued. Provide mechanical respiratory support if needed.

• Drugs that interfere with neuromuscular transmission
May interfere with neuromuscular transmission. Use with caution in myasthenic patients. Monitor the patient and increase the neostigmine dose as needed.

• Kanamycin, streptomycin
Neuromuscular blockade may be enhanced. Use these antibiotics in myasthenic patients only when clearly indicated. Closely monitor the patient. Adjust the neostigmine dose as needed.

• Local/General anesthetics, antiarrhythmic agents (eg, procainamide)
Use with caution in myasthenic patients; may interfere with neuromuscular transmission. Increase the neostigmine dose as needed.

• Quinine
Quinine may antagonize the effects of neostigmine. Avoid using quinine in patients receiving neostigmine for myasthenia gravis.

• Succinylcholine
Neuromuscular blockade produced by succinylcholine may be prolonged. Avoid this combination in the presence of a depolarizing (phase 1) type of neuromuscular blockade. Use with caution if a nondepolarizing (phase 2) type of blockade is present. Provide mechanical respiratory support as needed.

Side Effects: 

Cardiovascular:
Common (1% to 10%): Bradycardia, hypotension, tachycardia
Frequency not reported: Nonspecific EKG changes, cardiac arrest, syncope
Postmarketing reports: Cardiac arrhythmias (A-V block, nodal rhythm)

Dermatologic:
Common (1% to 10%): Pruritus
Frequency not reported: Rash, urticaria

Gastrointestinal:
Common (1% to 10%): Dry mouth, nausea (including post-procedural), vomiting
Frequency not reported: Flatulence, increased peristalsis
Postmarketing reports: Bowel cramps, diarrhea

Genitourinary:
Frequency not reported: Urinary frequency

Hypersensitivity:
Frequency not reported: Allergic reactions and anaphylaxis

Musculoskeletal:
Frequency not reported: Muscle cramps and spasms, arthralgia
Postmarketing reports: Muscle weakness

Nervous system:
Common (1% to 10%): Dizziness, headache, postoperative shivering, prolonged neuromuscular blockade, insomnia
Postmarketing reports: Convulsions, drowsiness, dysarthria, fasciculation, loss of consciousness

Ocular:
Frequency not reported: Miosis, visual changes

Other:
Common (1% to 10%): Incision site complication, procedural complication and pain
Frequency not reported: Diaphoresis, flushing, weakness

Renal:
Postmarketing reports: Urinary frequency

Respiratory:
Common (1% to 10%): Pharyngolaryngeal pain, dyspnea, oxygen desaturation (less than 90%)
Frequency not reported: Increased oral, pharyngeal and bronchial secretions, dyspnea, respiratory depression, respiratory arrest, bronchospasm

Storage: 

• Store below 30 C°
• Protect from light and freezing

Packing: 

• Injection 0.5mg/1ml: Box of 10 Ampoules
• Injection 2.5mg/1ml: Box of 10 Ampoules

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• Anticholinergic agents (eg, atropine, belladonna)
Intestinal motility may be slowed, increasing neostigmine absorption. Use with caution. Adjust the neostigmine dose as needed.

• Beta-blockers (eg, propranolol)
Severe or prolonged bradycardia may occur because of additive pharmacologic effects. Use with caution. Larger dosages of atropine and sympathomimetic pressor agents may be needed to reverse bradycardia and hypotension.

• Corticosteroids (eg, corticotropin, hydrocortisone)
The effects of neostigmine may be decreased. In addition, the effects of neostigmine may be increased after corticosteroids are discontinued. Provide mechanical respiratory support if needed.

• Drugs that interfere with neuromuscular transmission
May interfere with neuromuscular transmission. Use with caution in myasthenic patients. Monitor the patient and increase the neostigmine dose as needed.

• Kanamycin, streptomycin
Neuromuscular blockade may be enhanced. Use these antibiotics in myasthenic patients only when clearly indicated. Closely monitor the patient. Adjust the neostigmine dose as needed.

• Local/General anesthetics, antiarrhythmic agents (eg, procainamide)
Use with caution in myasthenic patients; may interfere with neuromuscular transmission. Increase the neostigmine dose as needed.

• Quinine
Quinine may antagonize the effects of neostigmine. Avoid using quinine in patients receiving neostigmine for myasthenia gravis.

• Succinylcholine
Neuromuscular blockade produced by succinylcholine may be prolonged. Avoid this combination in the presence of a depolarizing (phase 1) type of neuromuscular blockade. Use with caution if a nondepolarizing (phase 2) type of blockade is present. Provide mechanical respiratory support as needed.

[view] =>

• Anticholinergic agents (eg, atropine, belladonna)
Intestinal motility may be slowed, increasing neostigmine absorption. Use with caution. Adjust the neostigmine dose as needed.

• Beta-blockers (eg, propranolol)
Severe or prolonged bradycardia may occur because of additive pharmacologic effects. Use with caution. Larger dosages of atropine and sympathomimetic pressor agents may be needed to reverse bradycardia and hypotension.

• Corticosteroids (eg, corticotropin, hydrocortisone)
The effects of neostigmine may be decreased. In addition, the effects of neostigmine may be increased after corticosteroids are discontinued. Provide mechanical respiratory support if needed.

• Drugs that interfere with neuromuscular transmission
May interfere with neuromuscular transmission. Use with caution in myasthenic patients. Monitor the patient and increase the neostigmine dose as needed.

• Kanamycin, streptomycin
Neuromuscular blockade may be enhanced. Use these antibiotics in myasthenic patients only when clearly indicated. Closely monitor the patient. Adjust the neostigmine dose as needed.

• Local/General anesthetics, antiarrhythmic agents (eg, procainamide)
Use with caution in myasthenic patients; may interfere with neuromuscular transmission. Increase the neostigmine dose as needed.

• Quinine
Quinine may antagonize the effects of neostigmine. Avoid using quinine in patients receiving neostigmine for myasthenia gravis.

• Succinylcholine
Neuromuscular blockade produced by succinylcholine may be prolonged. Avoid this combination in the presence of a depolarizing (phase 1) type of neuromuscular blockade. Use with caution if a nondepolarizing (phase 2) type of blockade is present. Provide mechanical respiratory support as needed.

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Symptomatic control of myasthenia gravis; antidote for nondepolarizing neuromuscular blocking agents after surgery; prevention and treatment of postoperative distention and urinary retention (IV only).

[view] =>

Symptomatic control of myasthenia gravis; antidote for nondepolarizing neuromuscular blocking agents after surgery; prevention and treatment of postoperative distention and urinary retention (IV only).

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• Injection 0.5mg/1ml: Box of 10 Ampoules
• Injection 2.5mg/1ml: Box of 10 Ampoules

[view] =>

• Injection 0.5mg/1ml: Box of 10 Ampoules
• Injection 2.5mg/1ml: Box of 10 Ampoules

) ) [field_pdf] => Array ( [0] => Array ( [fid] => 175 [uid] => 1 [filename] => neostigmine.pdf [filepath] => sites/default/files/pdf/neostigmine.pdf [filemime] => application/pdf [filesize] => 138245 [status] => 1 [timestamp] => 1329487216 [list] => 1 [data] => [i18nsync] => 1 [nid] => 277 [view] => ) ) [field_pharmacokinetics] => Array ( [0] => Array ( [value] => Rapid absorption, protein binding is 15% to 25% (serum albumin). Neostigmine is metabolized in the liver by microsomal enzymes and undergoes hydrolysis by cholinesterase. It`s is eliminated in urine (50% as unchanged). Half-life is 51 to 90 min and plasma half-life is 47 to 60 min (IV). [format] => 1 [safe] =>

Rapid absorption, protein binding is 15% to 25% (serum albumin). Neostigmine is metabolized in the liver by microsomal enzymes and undergoes hydrolysis by cholinesterase. It`s is eliminated in urine (50% as unchanged). Half-life is 51 to 90 min and plasma half-life is 47 to 60 min (IV).

[view] =>

Rapid absorption, protein binding is 15% to 25% (serum albumin). Neostigmine is metabolized in the liver by microsomal enzymes and undergoes hydrolysis by cholinesterase. It`s is eliminated in urine (50% as unchanged). Half-life is 51 to 90 min and plasma half-life is 47 to 60 min (IV).

) ) [field_pharmacological_category] => Array ( [0] => Array ( [value] => Parasympathomimetic (Cholinergic) Agents [format] => 1 [safe] =>

Parasympathomimetic (Cholinergic) Agents

[view] =>

Parasympathomimetic (Cholinergic) Agents

) ) [field_precautions] => Array ( [0] => Array ( [value] => • For IV, subcutaneous, or IM administration. Not for intradermal or intra-arterial administration. • Do not administer if particulate matter or discoloration is noted. • Patients on IV neostigmine can be transferred to the oral form as soon as it can be tolerated. • Tablets • Administer as prescribed. Size of dose (eg, number of tablets) and frequency of administration will be adjusted to provide max relief of myasthenia gravis symptoms. • Administer without regard to meals. Administer with food if GI upset occurs. • Larger portions of the daily dose may be given at times when the patient is more prone to fatigue (eg, afternoons, mealtimes). • Large doses should be avoided in situations where there might be an increased absorption rate from the intestinal tract. • Ensure that parenteral atropine is available for emergency treatment of cholinergic crisis. [format] => 1 [safe] =>

• For IV, subcutaneous, or IM administration. Not for intradermal or intra-arterial administration.
• Do not administer if particulate matter or discoloration is noted.
• Patients on IV neostigmine can be transferred to the oral form as soon as it can be tolerated.
• Tablets
• Administer as prescribed. Size of dose (eg, number of tablets) and frequency of administration will be adjusted to provide max relief of myasthenia gravis symptoms.
• Administer without regard to meals. Administer with food if GI upset occurs.
• Larger portions of the daily dose may be given at times when the patient is more prone to fatigue (eg, afternoons, mealtimes).
• Large doses should be avoided in situations where there might be an increased absorption rate from the intestinal tract.
• Ensure that parenteral atropine is available for emergency treatment of cholinergic crisis.

[view] =>

• For IV, subcutaneous, or IM administration. Not for intradermal or intra-arterial administration.
• Do not administer if particulate matter or discoloration is noted.
• Patients on IV neostigmine can be transferred to the oral form as soon as it can be tolerated.
• Tablets
• Administer as prescribed. Size of dose (eg, number of tablets) and frequency of administration will be adjusted to provide max relief of myasthenia gravis symptoms.
• Administer without regard to meals. Administer with food if GI upset occurs.
• Larger portions of the daily dose may be given at times when the patient is more prone to fatigue (eg, afternoons, mealtimes).
• Large doses should be avoided in situations where there might be an increased absorption rate from the intestinal tract.
• Ensure that parenteral atropine is available for emergency treatment of cholinergic crisis.

) ) [field_pregnancy_category] => Array ( [0] => Array ( [value] => category C [format] => 1 [safe] =>

category C

[view] =>

category C

) ) [field_references] => Array ( [0] => Array ( [value] => [format] => [safe] => [view] => ) ) [field_side_effects] => Array ( [0] => Array ( [value] => Cardiovascular: Common (1% to 10%): Bradycardia, hypotension, tachycardia Frequency not reported: Nonspecific EKG changes, cardiac arrest, syncope Postmarketing reports: Cardiac arrhythmias (A-V block, nodal rhythm) Dermatologic: Common (1% to 10%): Pruritus Frequency not reported: Rash, urticaria Gastrointestinal: Common (1% to 10%): Dry mouth, nausea (including post-procedural), vomiting Frequency not reported: Flatulence, increased peristalsis Postmarketing reports: Bowel cramps, diarrhea Genitourinary: Frequency not reported: Urinary frequency Hypersensitivity: Frequency not reported: Allergic reactions and anaphylaxis Musculoskeletal: Frequency not reported: Muscle cramps and spasms, arthralgia Postmarketing reports: Muscle weakness Nervous system: Common (1% to 10%): Dizziness, headache, postoperative shivering, prolonged neuromuscular blockade, insomnia Postmarketing reports: Convulsions, drowsiness, dysarthria, fasciculation, loss of consciousness Ocular: Frequency not reported: Miosis, visual changes Other: Common (1% to 10%): Incision site complication, procedural complication and pain Frequency not reported: Diaphoresis, flushing, weakness Renal: Postmarketing reports: Urinary frequency Respiratory: Common (1% to 10%): Pharyngolaryngeal pain, dyspnea, oxygen desaturation (less than 90%) Frequency not reported: Increased oral, pharyngeal and bronchial secretions, dyspnea, respiratory depression, respiratory arrest, bronchospasm [format] => 1 [safe] =>

Cardiovascular:
Common (1% to 10%): Bradycardia, hypotension, tachycardia
Frequency not reported: Nonspecific EKG changes, cardiac arrest, syncope
Postmarketing reports: Cardiac arrhythmias (A-V block, nodal rhythm)

Dermatologic:
Common (1% to 10%): Pruritus
Frequency not reported: Rash, urticaria

Gastrointestinal:
Common (1% to 10%): Dry mouth, nausea (including post-procedural), vomiting
Frequency not reported: Flatulence, increased peristalsis
Postmarketing reports: Bowel cramps, diarrhea

Genitourinary:
Frequency not reported: Urinary frequency

Hypersensitivity:
Frequency not reported: Allergic reactions and anaphylaxis

Musculoskeletal:
Frequency not reported: Muscle cramps and spasms, arthralgia
Postmarketing reports: Muscle weakness

Nervous system:
Common (1% to 10%): Dizziness, headache, postoperative shivering, prolonged neuromuscular blockade, insomnia
Postmarketing reports: Convulsions, drowsiness, dysarthria, fasciculation, loss of consciousness

Ocular:
Frequency not reported: Miosis, visual changes

Other:
Common (1% to 10%): Incision site complication, procedural complication and pain
Frequency not reported: Diaphoresis, flushing, weakness

Renal:
Postmarketing reports: Urinary frequency

Respiratory:
Common (1% to 10%): Pharyngolaryngeal pain, dyspnea, oxygen desaturation (less than 90%)
Frequency not reported: Increased oral, pharyngeal and bronchial secretions, dyspnea, respiratory depression, respiratory arrest, bronchospasm

[view] =>

Cardiovascular:
Common (1% to 10%): Bradycardia, hypotension, tachycardia
Frequency not reported: Nonspecific EKG changes, cardiac arrest, syncope
Postmarketing reports: Cardiac arrhythmias (A-V block, nodal rhythm)

Dermatologic:
Common (1% to 10%): Pruritus
Frequency not reported: Rash, urticaria

Gastrointestinal:
Common (1% to 10%): Dry mouth, nausea (including post-procedural), vomiting
Frequency not reported: Flatulence, increased peristalsis
Postmarketing reports: Bowel cramps, diarrhea

Genitourinary:
Frequency not reported: Urinary frequency

Hypersensitivity:
Frequency not reported: Allergic reactions and anaphylaxis

Musculoskeletal:
Frequency not reported: Muscle cramps and spasms, arthralgia
Postmarketing reports: Muscle weakness

Nervous system:
Common (1% to 10%): Dizziness, headache, postoperative shivering, prolonged neuromuscular blockade, insomnia
Postmarketing reports: Convulsions, drowsiness, dysarthria, fasciculation, loss of consciousness

Ocular:
Frequency not reported: Miosis, visual changes

Other:
Common (1% to 10%): Incision site complication, procedural complication and pain
Frequency not reported: Diaphoresis, flushing, weakness

Renal:
Postmarketing reports: Urinary frequency

Respiratory:
Common (1% to 10%): Pharyngolaryngeal pain, dyspnea, oxygen desaturation (less than 90%)
Frequency not reported: Increased oral, pharyngeal and bronchial secretions, dyspnea, respiratory depression, respiratory arrest, bronchospasm

) ) [field_storage] => Array ( [0] => Array ( [value] => • Store below 30 C° • Protect from light and freezing [format] => 1 [safe] =>

• Store below 30 C°
• Protect from light and freezing

[view] =>

• Store below 30 C°
• Protect from light and freezing

) ) [field_therapeutic_category] => Array ( [0] => Array ( [value] => Antimyasthenic,Muscle Relaxant [format] => 1 [safe] =>

Antimyasthenic,Muscle Relaxant

[view] =>

Antimyasthenic,Muscle Relaxant

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Image: 
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IPOSTIGMINE®

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IPOSTIGMINE®

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IPOSTIGMINE®

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IPOSTIGMINE®

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Brand Name: 

IPOSTIGMINE®

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Injection 0.5mg/1ml - Injection2.5mg/1ml

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Injection 0.5mg/1ml - Injection2.5mg/1ml

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Injection 0.5mg/1ml - Injection2.5mg/1ml

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Injection 0.5mg/1ml - Injection2.5mg/1ml

[#printed] => 1 ) [#title] => [#description] => [#children] =>
Dosage Form: 

Injection 0.5mg/1ml - Injection2.5mg/1ml

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Parasympathomimetic (Cholinergic) Agents

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Parasympathomimetic (Cholinergic) Agents

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Parasympathomimetic (Cholinergic) Agents

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Parasympathomimetic (Cholinergic) Agents

[#printed] => 1 ) [#title] => [#description] => [#children] =>
Pharmacological Category: 

Parasympathomimetic (Cholinergic) Agents

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Antimyasthenic,Muscle Relaxant

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Antimyasthenic,Muscle Relaxant

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Antimyasthenic,Muscle Relaxant

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Antimyasthenic,Muscle Relaxant

[#printed] => 1 ) [#title] => [#description] => [#children] =>
Therapeutic Category: 

Antimyasthenic,Muscle Relaxant

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category C

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category C

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category C

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category C

[#printed] => 1 ) [#title] => [#description] => [#children] =>
Pregnancy Category: 

category C

[#printed] => 1 ) [body] => Array ( [#weight] => 3 [#value] =>

Facilitates myoneural junction impulse transmission by inhibiting acetylcholine destruction by cholinesterase.

[#title] => [#description] => [#printed] => 1 ) [field_pharmacokinetics] => Array ( [#type_name] => product [#context] => full [#field_name] => field_pharmacokinetics [#post_render] => Array ( [0] => content_field_wrapper_post_render ) [#weight] => 4 [field] => Array ( [#description] => [items] => Array ( [0] => Array ( [#formatter] => default [#node] => stdClass Object *RECURSION* [#type_name] => product [#field_name] => field_pharmacokinetics [#weight] => 0 [#theme] => text_formatter_default [#item] => Array ( [value] => Rapid absorption, protein binding is 15% to 25% (serum albumin). Neostigmine is metabolized in the liver by microsomal enzymes and undergoes hydrolysis by cholinesterase. It`s is eliminated in urine (50% as unchanged). Half-life is 51 to 90 min and plasma half-life is 47 to 60 min (IV). [format] => 1 [safe] =>

Rapid absorption, protein binding is 15% to 25% (serum albumin). Neostigmine is metabolized in the liver by microsomal enzymes and undergoes hydrolysis by cholinesterase. It`s is eliminated in urine (50% as unchanged). Half-life is 51 to 90 min and plasma half-life is 47 to 60 min (IV).

[#delta] => 0 ) [#title] => [#description] => [#theme_used] => 1 [#printed] => 1 [#type] => [#value] => [#prefix] => [#suffix] => [#children] =>

Rapid absorption, protein binding is 15% to 25% (serum albumin). Neostigmine is metabolized in the liver by microsomal enzymes and undergoes hydrolysis by cholinesterase. It`s is eliminated in urine (50% as unchanged). Half-life is 51 to 90 min and plasma half-life is 47 to 60 min (IV).

) [#title] => [#description] => [#children] =>

Rapid absorption, protein binding is 15% to 25% (serum albumin). Neostigmine is metabolized in the liver by microsomal enzymes and undergoes hydrolysis by cholinesterase. It`s is eliminated in urine (50% as unchanged). Half-life is 51 to 90 min and plasma half-life is 47 to 60 min (IV).

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Rapid absorption, protein binding is 15% to 25% (serum albumin). Neostigmine is metabolized in the liver by microsomal enzymes and undergoes hydrolysis by cholinesterase. It`s is eliminated in urine (50% as unchanged). Half-life is 51 to 90 min and plasma half-life is 47 to 60 min (IV).

[#printed] => 1 ) [#title] => [#description] => [#children] =>
Pharmacokinetics: 

Rapid absorption, protein binding is 15% to 25% (serum albumin). Neostigmine is metabolized in the liver by microsomal enzymes and undergoes hydrolysis by cholinesterase. It`s is eliminated in urine (50% as unchanged). Half-life is 51 to 90 min and plasma half-life is 47 to 60 min (IV).

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Symptomatic control of myasthenia gravis; antidote for nondepolarizing neuromuscular blocking agents after surgery; prevention and treatment of postoperative distention and urinary retention (IV only).

[#delta] => 0 ) [#title] => [#description] => [#theme_used] => 1 [#printed] => 1 [#type] => [#value] => [#prefix] => [#suffix] => [#children] =>

Symptomatic control of myasthenia gravis; antidote for nondepolarizing neuromuscular blocking agents after surgery; prevention and treatment of postoperative distention and urinary retention (IV only).

) [#title] => [#description] => [#children] =>

Symptomatic control of myasthenia gravis; antidote for nondepolarizing neuromuscular blocking agents after surgery; prevention and treatment of postoperative distention and urinary retention (IV only).

[#printed] => 1 ) [#single] => 1 [#attributes] => Array ( ) [#required] => [#parents] => Array ( ) [#tree] => [#context] => full [#page] => 1 [#field_name] => field_indications [#title] => Indications [#access] => 1 [#label_display] => above [#teaser] => [#node] => stdClass Object *RECURSION* [#type] => content_field [#children] =>

Symptomatic control of myasthenia gravis; antidote for nondepolarizing neuromuscular blocking agents after surgery; prevention and treatment of postoperative distention and urinary retention (IV only).

[#printed] => 1 ) [#title] => [#description] => [#children] =>
Indications: 

Symptomatic control of myasthenia gravis; antidote for nondepolarizing neuromuscular blocking agents after surgery; prevention and treatment of postoperative distention and urinary retention (IV only).

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Hypersensitivity to anticholinesterases and bromides; mechanical intestinal or urinary obstruction; peritonitis

[#delta] => 0 ) [#title] => [#description] => [#theme_used] => 1 [#printed] => 1 [#type] => [#value] => [#prefix] => [#suffix] => [#children] =>

Hypersensitivity to anticholinesterases and bromides; mechanical intestinal or urinary obstruction; peritonitis

) [#title] => [#description] => [#children] =>

Hypersensitivity to anticholinesterases and bromides; mechanical intestinal or urinary obstruction; peritonitis

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Hypersensitivity to anticholinesterases and bromides; mechanical intestinal or urinary obstruction; peritonitis

[#printed] => 1 ) [#title] => [#description] => [#children] =>
Contraindications: 

Hypersensitivity to anticholinesterases and bromides; mechanical intestinal or urinary obstruction; peritonitis

[#printed] => 1 ) [field_precautions] => Array ( [#type_name] => product [#context] => full [#field_name] => field_precautions [#post_render] => Array ( [0] => content_field_wrapper_post_render ) [#weight] => 8 [field] => Array ( [#description] => [items] => Array ( [0] => Array ( [#formatter] => default [#node] => stdClass Object *RECURSION* [#type_name] => product [#field_name] => field_precautions [#weight] => 0 [#theme] => text_formatter_default [#item] => Array ( [value] => • For IV, subcutaneous, or IM administration. Not for intradermal or intra-arterial administration. • Do not administer if particulate matter or discoloration is noted. • Patients on IV neostigmine can be transferred to the oral form as soon as it can be tolerated. • Tablets • Administer as prescribed. Size of dose (eg, number of tablets) and frequency of administration will be adjusted to provide max relief of myasthenia gravis symptoms. • Administer without regard to meals. Administer with food if GI upset occurs. • Larger portions of the daily dose may be given at times when the patient is more prone to fatigue (eg, afternoons, mealtimes). • Large doses should be avoided in situations where there might be an increased absorption rate from the intestinal tract. • Ensure that parenteral atropine is available for emergency treatment of cholinergic crisis. [format] => 1 [safe] =>

• For IV, subcutaneous, or IM administration. Not for intradermal or intra-arterial administration.
• Do not administer if particulate matter or discoloration is noted.
• Patients on IV neostigmine can be transferred to the oral form as soon as it can be tolerated.
• Tablets
• Administer as prescribed. Size of dose (eg, number of tablets) and frequency of administration will be adjusted to provide max relief of myasthenia gravis symptoms.
• Administer without regard to meals. Administer with food if GI upset occurs.
• Larger portions of the daily dose may be given at times when the patient is more prone to fatigue (eg, afternoons, mealtimes).
• Large doses should be avoided in situations where there might be an increased absorption rate from the intestinal tract.
• Ensure that parenteral atropine is available for emergency treatment of cholinergic crisis.

[#delta] => 0 ) [#title] => [#description] => [#theme_used] => 1 [#printed] => 1 [#type] => [#value] => [#prefix] => [#suffix] => [#children] =>

• For IV, subcutaneous, or IM administration. Not for intradermal or intra-arterial administration.
• Do not administer if particulate matter or discoloration is noted.
• Patients on IV neostigmine can be transferred to the oral form as soon as it can be tolerated.
• Tablets
• Administer as prescribed. Size of dose (eg, number of tablets) and frequency of administration will be adjusted to provide max relief of myasthenia gravis symptoms.
• Administer without regard to meals. Administer with food if GI upset occurs.
• Larger portions of the daily dose may be given at times when the patient is more prone to fatigue (eg, afternoons, mealtimes).
• Large doses should be avoided in situations where there might be an increased absorption rate from the intestinal tract.
• Ensure that parenteral atropine is available for emergency treatment of cholinergic crisis.

) [#title] => [#description] => [#children] =>

• For IV, subcutaneous, or IM administration. Not for intradermal or intra-arterial administration.
• Do not administer if particulate matter or discoloration is noted.
• Patients on IV neostigmine can be transferred to the oral form as soon as it can be tolerated.
• Tablets
• Administer as prescribed. Size of dose (eg, number of tablets) and frequency of administration will be adjusted to provide max relief of myasthenia gravis symptoms.
• Administer without regard to meals. Administer with food if GI upset occurs.
• Larger portions of the daily dose may be given at times when the patient is more prone to fatigue (eg, afternoons, mealtimes).
• Large doses should be avoided in situations where there might be an increased absorption rate from the intestinal tract.
• Ensure that parenteral atropine is available for emergency treatment of cholinergic crisis.

[#printed] => 1 ) [#single] => 1 [#attributes] => Array ( ) [#required] => [#parents] => Array ( ) [#tree] => [#context] => full [#page] => 1 [#field_name] => field_precautions [#title] => Precautions [#access] => 1 [#label_display] => above [#teaser] => [#node] => stdClass Object *RECURSION* [#type] => content_field [#children] =>

• For IV, subcutaneous, or IM administration. Not for intradermal or intra-arterial administration.
• Do not administer if particulate matter or discoloration is noted.
• Patients on IV neostigmine can be transferred to the oral form as soon as it can be tolerated.
• Tablets
• Administer as prescribed. Size of dose (eg, number of tablets) and frequency of administration will be adjusted to provide max relief of myasthenia gravis symptoms.
• Administer without regard to meals. Administer with food if GI upset occurs.
• Larger portions of the daily dose may be given at times when the patient is more prone to fatigue (eg, afternoons, mealtimes).
• Large doses should be avoided in situations where there might be an increased absorption rate from the intestinal tract.
• Ensure that parenteral atropine is available for emergency treatment of cholinergic crisis.

[#printed] => 1 ) [#title] => [#description] => [#children] =>
Precautions: 

• For IV, subcutaneous, or IM administration. Not for intradermal or intra-arterial administration.
• Do not administer if particulate matter or discoloration is noted.
• Patients on IV neostigmine can be transferred to the oral form as soon as it can be tolerated.
• Tablets
• Administer as prescribed. Size of dose (eg, number of tablets) and frequency of administration will be adjusted to provide max relief of myasthenia gravis symptoms.
• Administer without regard to meals. Administer with food if GI upset occurs.
• Larger portions of the daily dose may be given at times when the patient is more prone to fatigue (eg, afternoons, mealtimes).
• Large doses should be avoided in situations where there might be an increased absorption rate from the intestinal tract.
• Ensure that parenteral atropine is available for emergency treatment of cholinergic crisis.

[#printed] => 1 ) [field_drug_interactions] => Array ( [#type_name] => product [#context] => full [#field_name] => field_drug_interactions [#post_render] => Array ( [0] => content_field_wrapper_post_render ) [#weight] => 9 [field] => Array ( [#description] => [items] => Array ( [0] => Array ( [#formatter] => default [#node] => stdClass Object *RECURSION* [#type_name] => product [#field_name] => field_drug_interactions [#weight] => 0 [#theme] => text_formatter_default [#item] => Array ( [value] => • Anticholinergic agents (eg, atropine, belladonna) Intestinal motility may be slowed, increasing neostigmine absorption. Use with caution. Adjust the neostigmine dose as needed. • Beta-blockers (eg, propranolol) Severe or prolonged bradycardia may occur because of additive pharmacologic effects. Use with caution. Larger dosages of atropine and sympathomimetic pressor agents may be needed to reverse bradycardia and hypotension. • Corticosteroids (eg, corticotropin, hydrocortisone) The effects of neostigmine may be decreased. In addition, the effects of neostigmine may be increased after corticosteroids are discontinued. Provide mechanical respiratory support if needed. • Drugs that interfere with neuromuscular transmission May interfere with neuromuscular transmission. Use with caution in myasthenic patients. Monitor the patient and increase the neostigmine dose as needed. • Kanamycin, streptomycin Neuromuscular blockade may be enhanced. Use these antibiotics in myasthenic patients only when clearly indicated. Closely monitor the patient. Adjust the neostigmine dose as needed. • Local/General anesthetics, antiarrhythmic agents (eg, procainamide) Use with caution in myasthenic patients; may interfere with neuromuscular transmission. Increase the neostigmine dose as needed. • Quinine Quinine may antagonize the effects of neostigmine. Avoid using quinine in patients receiving neostigmine for myasthenia gravis. • Succinylcholine Neuromuscular blockade produced by succinylcholine may be prolonged. Avoid this combination in the presence of a depolarizing (phase 1) type of neuromuscular blockade. Use with caution if a nondepolarizing (phase 2) type of blockade is present. Provide mechanical respiratory support as needed. [format] => 1 [safe] =>

• Anticholinergic agents (eg, atropine, belladonna)
Intestinal motility may be slowed, increasing neostigmine absorption. Use with caution. Adjust the neostigmine dose as needed.

• Beta-blockers (eg, propranolol)
Severe or prolonged bradycardia may occur because of additive pharmacologic effects. Use with caution. Larger dosages of atropine and sympathomimetic pressor agents may be needed to reverse bradycardia and hypotension.

• Corticosteroids (eg, corticotropin, hydrocortisone)
The effects of neostigmine may be decreased. In addition, the effects of neostigmine may be increased after corticosteroids are discontinued. Provide mechanical respiratory support if needed.

• Drugs that interfere with neuromuscular transmission
May interfere with neuromuscular transmission. Use with caution in myasthenic patients. Monitor the patient and increase the neostigmine dose as needed.

• Kanamycin, streptomycin
Neuromuscular blockade may be enhanced. Use these antibiotics in myasthenic patients only when clearly indicated. Closely monitor the patient. Adjust the neostigmine dose as needed.

• Local/General anesthetics, antiarrhythmic agents (eg, procainamide)
Use with caution in myasthenic patients; may interfere with neuromuscular transmission. Increase the neostigmine dose as needed.

• Quinine
Quinine may antagonize the effects of neostigmine. Avoid using quinine in patients receiving neostigmine for myasthenia gravis.

• Succinylcholine
Neuromuscular blockade produced by succinylcholine may be prolonged. Avoid this combination in the presence of a depolarizing (phase 1) type of neuromuscular blockade. Use with caution if a nondepolarizing (phase 2) type of blockade is present. Provide mechanical respiratory support as needed.

[#delta] => 0 ) [#title] => [#description] => [#theme_used] => 1 [#printed] => 1 [#type] => [#value] => [#prefix] => [#suffix] => [#children] =>

• Anticholinergic agents (eg, atropine, belladonna)
Intestinal motility may be slowed, increasing neostigmine absorption. Use with caution. Adjust the neostigmine dose as needed.

• Beta-blockers (eg, propranolol)
Severe or prolonged bradycardia may occur because of additive pharmacologic effects. Use with caution. Larger dosages of atropine and sympathomimetic pressor agents may be needed to reverse bradycardia and hypotension.

• Corticosteroids (eg, corticotropin, hydrocortisone)
The effects of neostigmine may be decreased. In addition, the effects of neostigmine may be increased after corticosteroids are discontinued. Provide mechanical respiratory support if needed.

• Drugs that interfere with neuromuscular transmission
May interfere with neuromuscular transmission. Use with caution in myasthenic patients. Monitor the patient and increase the neostigmine dose as needed.

• Kanamycin, streptomycin
Neuromuscular blockade may be enhanced. Use these antibiotics in myasthenic patients only when clearly indicated. Closely monitor the patient. Adjust the neostigmine dose as needed.

• Local/General anesthetics, antiarrhythmic agents (eg, procainamide)
Use with caution in myasthenic patients; may interfere with neuromuscular transmission. Increase the neostigmine dose as needed.

• Quinine
Quinine may antagonize the effects of neostigmine. Avoid using quinine in patients receiving neostigmine for myasthenia gravis.

• Succinylcholine
Neuromuscular blockade produced by succinylcholine may be prolonged. Avoid this combination in the presence of a depolarizing (phase 1) type of neuromuscular blockade. Use with caution if a nondepolarizing (phase 2) type of blockade is present. Provide mechanical respiratory support as needed.

) [#title] => [#description] => [#children] =>

• Anticholinergic agents (eg, atropine, belladonna)
Intestinal motility may be slowed, increasing neostigmine absorption. Use with caution. Adjust the neostigmine dose as needed.

• Beta-blockers (eg, propranolol)
Severe or prolonged bradycardia may occur because of additive pharmacologic effects. Use with caution. Larger dosages of atropine and sympathomimetic pressor agents may be needed to reverse bradycardia and hypotension.

• Corticosteroids (eg, corticotropin, hydrocortisone)
The effects of neostigmine may be decreased. In addition, the effects of neostigmine may be increased after corticosteroids are discontinued. Provide mechanical respiratory support if needed.

• Drugs that interfere with neuromuscular transmission
May interfere with neuromuscular transmission. Use with caution in myasthenic patients. Monitor the patient and increase the neostigmine dose as needed.

• Kanamycin, streptomycin
Neuromuscular blockade may be enhanced. Use these antibiotics in myasthenic patients only when clearly indicated. Closely monitor the patient. Adjust the neostigmine dose as needed.

• Local/General anesthetics, antiarrhythmic agents (eg, procainamide)
Use with caution in myasthenic patients; may interfere with neuromuscular transmission. Increase the neostigmine dose as needed.

• Quinine
Quinine may antagonize the effects of neostigmine. Avoid using quinine in patients receiving neostigmine for myasthenia gravis.

• Succinylcholine
Neuromuscular blockade produced by succinylcholine may be prolonged. Avoid this combination in the presence of a depolarizing (phase 1) type of neuromuscular blockade. Use with caution if a nondepolarizing (phase 2) type of blockade is present. Provide mechanical respiratory support as needed.

[#printed] => 1 ) [#single] => 1 [#attributes] => Array ( ) [#required] => [#parents] => Array ( ) [#tree] => [#context] => full [#page] => 1 [#field_name] => field_drug_interactions [#title] => Drug Interactions [#access] => 1 [#label_display] => above [#teaser] => [#node] => stdClass Object *RECURSION* [#type] => content_field [#children] =>

• Anticholinergic agents (eg, atropine, belladonna)
Intestinal motility may be slowed, increasing neostigmine absorption. Use with caution. Adjust the neostigmine dose as needed.

• Beta-blockers (eg, propranolol)
Severe or prolonged bradycardia may occur because of additive pharmacologic effects. Use with caution. Larger dosages of atropine and sympathomimetic pressor agents may be needed to reverse bradycardia and hypotension.

• Corticosteroids (eg, corticotropin, hydrocortisone)
The effects of neostigmine may be decreased. In addition, the effects of neostigmine may be increased after corticosteroids are discontinued. Provide mechanical respiratory support if needed.

• Drugs that interfere with neuromuscular transmission
May interfere with neuromuscular transmission. Use with caution in myasthenic patients. Monitor the patient and increase the neostigmine dose as needed.

• Kanamycin, streptomycin
Neuromuscular blockade may be enhanced. Use these antibiotics in myasthenic patients only when clearly indicated. Closely monitor the patient. Adjust the neostigmine dose as needed.

• Local/General anesthetics, antiarrhythmic agents (eg, procainamide)
Use with caution in myasthenic patients; may interfere with neuromuscular transmission. Increase the neostigmine dose as needed.

• Quinine
Quinine may antagonize the effects of neostigmine. Avoid using quinine in patients receiving neostigmine for myasthenia gravis.

• Succinylcholine
Neuromuscular blockade produced by succinylcholine may be prolonged. Avoid this combination in the presence of a depolarizing (phase 1) type of neuromuscular blockade. Use with caution if a nondepolarizing (phase 2) type of blockade is present. Provide mechanical respiratory support as needed.

[#printed] => 1 ) [#title] => [#description] => [#children] =>
Drug Interactions: 

• Anticholinergic agents (eg, atropine, belladonna)
Intestinal motility may be slowed, increasing neostigmine absorption. Use with caution. Adjust the neostigmine dose as needed.

• Beta-blockers (eg, propranolol)
Severe or prolonged bradycardia may occur because of additive pharmacologic effects. Use with caution. Larger dosages of atropine and sympathomimetic pressor agents may be needed to reverse bradycardia and hypotension.

• Corticosteroids (eg, corticotropin, hydrocortisone)
The effects of neostigmine may be decreased. In addition, the effects of neostigmine may be increased after corticosteroids are discontinued. Provide mechanical respiratory support if needed.

• Drugs that interfere with neuromuscular transmission
May interfere with neuromuscular transmission. Use with caution in myasthenic patients. Monitor the patient and increase the neostigmine dose as needed.

• Kanamycin, streptomycin
Neuromuscular blockade may be enhanced. Use these antibiotics in myasthenic patients only when clearly indicated. Closely monitor the patient. Adjust the neostigmine dose as needed.

• Local/General anesthetics, antiarrhythmic agents (eg, procainamide)
Use with caution in myasthenic patients; may interfere with neuromuscular transmission. Increase the neostigmine dose as needed.

• Quinine
Quinine may antagonize the effects of neostigmine. Avoid using quinine in patients receiving neostigmine for myasthenia gravis.

• Succinylcholine
Neuromuscular blockade produced by succinylcholine may be prolonged. Avoid this combination in the presence of a depolarizing (phase 1) type of neuromuscular blockade. Use with caution if a nondepolarizing (phase 2) type of blockade is present. Provide mechanical respiratory support as needed.

[#printed] => 1 ) [field_side_effects] => Array ( [#type_name] => product [#context] => full [#field_name] => field_side_effects [#post_render] => Array ( [0] => content_field_wrapper_post_render ) [#weight] => 10 [field] => Array ( [#description] => [items] => Array ( [0] => Array ( [#formatter] => default [#node] => stdClass Object *RECURSION* [#type_name] => product [#field_name] => field_side_effects [#weight] => 0 [#theme] => text_formatter_default [#item] => Array ( [value] => Cardiovascular: Common (1% to 10%): Bradycardia, hypotension, tachycardia Frequency not reported: Nonspecific EKG changes, cardiac arrest, syncope Postmarketing reports: Cardiac arrhythmias (A-V block, nodal rhythm) Dermatologic: Common (1% to 10%): Pruritus Frequency not reported: Rash, urticaria Gastrointestinal: Common (1% to 10%): Dry mouth, nausea (including post-procedural), vomiting Frequency not reported: Flatulence, increased peristalsis Postmarketing reports: Bowel cramps, diarrhea Genitourinary: Frequency not reported: Urinary frequency Hypersensitivity: Frequency not reported: Allergic reactions and anaphylaxis Musculoskeletal: Frequency not reported: Muscle cramps and spasms, arthralgia Postmarketing reports: Muscle weakness Nervous system: Common (1% to 10%): Dizziness, headache, postoperative shivering, prolonged neuromuscular blockade, insomnia Postmarketing reports: Convulsions, drowsiness, dysarthria, fasciculation, loss of consciousness Ocular: Frequency not reported: Miosis, visual changes Other: Common (1% to 10%): Incision site complication, procedural complication and pain Frequency not reported: Diaphoresis, flushing, weakness Renal: Postmarketing reports: Urinary frequency Respiratory: Common (1% to 10%): Pharyngolaryngeal pain, dyspnea, oxygen desaturation (less than 90%) Frequency not reported: Increased oral, pharyngeal and bronchial secretions, dyspnea, respiratory depression, respiratory arrest, bronchospasm [format] => 1 [safe] =>

Cardiovascular:
Common (1% to 10%): Bradycardia, hypotension, tachycardia
Frequency not reported: Nonspecific EKG changes, cardiac arrest, syncope
Postmarketing reports: Cardiac arrhythmias (A-V block, nodal rhythm)

Dermatologic:
Common (1% to 10%): Pruritus
Frequency not reported: Rash, urticaria

Gastrointestinal:
Common (1% to 10%): Dry mouth, nausea (including post-procedural), vomiting
Frequency not reported: Flatulence, increased peristalsis
Postmarketing reports: Bowel cramps, diarrhea

Genitourinary:
Frequency not reported: Urinary frequency

Hypersensitivity:
Frequency not reported: Allergic reactions and anaphylaxis

Musculoskeletal:
Frequency not reported: Muscle cramps and spasms, arthralgia
Postmarketing reports: Muscle weakness

Nervous system:
Common (1% to 10%): Dizziness, headache, postoperative shivering, prolonged neuromuscular blockade, insomnia
Postmarketing reports: Convulsions, drowsiness, dysarthria, fasciculation, loss of consciousness

Ocular:
Frequency not reported: Miosis, visual changes

Other:
Common (1% to 10%): Incision site complication, procedural complication and pain
Frequency not reported: Diaphoresis, flushing, weakness

Renal:
Postmarketing reports: Urinary frequency

Respiratory:
Common (1% to 10%): Pharyngolaryngeal pain, dyspnea, oxygen desaturation (less than 90%)
Frequency not reported: Increased oral, pharyngeal and bronchial secretions, dyspnea, respiratory depression, respiratory arrest, bronchospasm

[#delta] => 0 ) [#title] => [#description] => [#theme_used] => 1 [#printed] => 1 [#type] => [#value] => [#prefix] => [#suffix] => [#children] =>

Cardiovascular:
Common (1% to 10%): Bradycardia, hypotension, tachycardia
Frequency not reported: Nonspecific EKG changes, cardiac arrest, syncope
Postmarketing reports: Cardiac arrhythmias (A-V block, nodal rhythm)

Dermatologic:
Common (1% to 10%): Pruritus
Frequency not reported: Rash, urticaria

Gastrointestinal:
Common (1% to 10%): Dry mouth, nausea (including post-procedural), vomiting
Frequency not reported: Flatulence, increased peristalsis
Postmarketing reports: Bowel cramps, diarrhea

Genitourinary:
Frequency not reported: Urinary frequency

Hypersensitivity:
Frequency not reported: Allergic reactions and anaphylaxis

Musculoskeletal:
Frequency not reported: Muscle cramps and spasms, arthralgia
Postmarketing reports: Muscle weakness

Nervous system:
Common (1% to 10%): Dizziness, headache, postoperative shivering, prolonged neuromuscular blockade, insomnia
Postmarketing reports: Convulsions, drowsiness, dysarthria, fasciculation, loss of consciousness

Ocular:
Frequency not reported: Miosis, visual changes

Other:
Common (1% to 10%): Incision site complication, procedural complication and pain
Frequency not reported: Diaphoresis, flushing, weakness

Renal:
Postmarketing reports: Urinary frequency

Respiratory:
Common (1% to 10%): Pharyngolaryngeal pain, dyspnea, oxygen desaturation (less than 90%)
Frequency not reported: Increased oral, pharyngeal and bronchial secretions, dyspnea, respiratory depression, respiratory arrest, bronchospasm

) [#title] => [#description] => [#children] =>

Cardiovascular:
Common (1% to 10%): Bradycardia, hypotension, tachycardia
Frequency not reported: Nonspecific EKG changes, cardiac arrest, syncope
Postmarketing reports: Cardiac arrhythmias (A-V block, nodal rhythm)

Dermatologic:
Common (1% to 10%): Pruritus
Frequency not reported: Rash, urticaria

Gastrointestinal:
Common (1% to 10%): Dry mouth, nausea (including post-procedural), vomiting
Frequency not reported: Flatulence, increased peristalsis
Postmarketing reports: Bowel cramps, diarrhea

Genitourinary:
Frequency not reported: Urinary frequency

Hypersensitivity:
Frequency not reported: Allergic reactions and anaphylaxis

Musculoskeletal:
Frequency not reported: Muscle cramps and spasms, arthralgia
Postmarketing reports: Muscle weakness

Nervous system:
Common (1% to 10%): Dizziness, headache, postoperative shivering, prolonged neuromuscular blockade, insomnia
Postmarketing reports: Convulsions, drowsiness, dysarthria, fasciculation, loss of consciousness

Ocular:
Frequency not reported: Miosis, visual changes

Other:
Common (1% to 10%): Incision site complication, procedural complication and pain
Frequency not reported: Diaphoresis, flushing, weakness

Renal:
Postmarketing reports: Urinary frequency

Respiratory:
Common (1% to 10%): Pharyngolaryngeal pain, dyspnea, oxygen desaturation (less than 90%)
Frequency not reported: Increased oral, pharyngeal and bronchial secretions, dyspnea, respiratory depression, respiratory arrest, bronchospasm

[#printed] => 1 ) [#single] => 1 [#attributes] => Array ( ) [#required] => [#parents] => Array ( ) [#tree] => [#context] => full [#page] => 1 [#field_name] => field_side_effects [#title] => Side Effects [#access] => 1 [#label_display] => above [#teaser] => [#node] => stdClass Object *RECURSION* [#type] => content_field [#children] =>

Cardiovascular:
Common (1% to 10%): Bradycardia, hypotension, tachycardia
Frequency not reported: Nonspecific EKG changes, cardiac arrest, syncope
Postmarketing reports: Cardiac arrhythmias (A-V block, nodal rhythm)

Dermatologic:
Common (1% to 10%): Pruritus
Frequency not reported: Rash, urticaria

Gastrointestinal:
Common (1% to 10%): Dry mouth, nausea (including post-procedural), vomiting
Frequency not reported: Flatulence, increased peristalsis
Postmarketing reports: Bowel cramps, diarrhea

Genitourinary:
Frequency not reported: Urinary frequency

Hypersensitivity:
Frequency not reported: Allergic reactions and anaphylaxis

Musculoskeletal:
Frequency not reported: Muscle cramps and spasms, arthralgia
Postmarketing reports: Muscle weakness

Nervous system:
Common (1% to 10%): Dizziness, headache, postoperative shivering, prolonged neuromuscular blockade, insomnia
Postmarketing reports: Convulsions, drowsiness, dysarthria, fasciculation, loss of consciousness

Ocular:
Frequency not reported: Miosis, visual changes

Other:
Common (1% to 10%): Incision site complication, procedural complication and pain
Frequency not reported: Diaphoresis, flushing, weakness

Renal:
Postmarketing reports: Urinary frequency

Respiratory:
Common (1% to 10%): Pharyngolaryngeal pain, dyspnea, oxygen desaturation (less than 90%)
Frequency not reported: Increased oral, pharyngeal and bronchial secretions, dyspnea, respiratory depression, respiratory arrest, bronchospasm

[#printed] => 1 ) [#title] => [#description] => [#children] =>
Side Effects: 

Cardiovascular:
Common (1% to 10%): Bradycardia, hypotension, tachycardia
Frequency not reported: Nonspecific EKG changes, cardiac arrest, syncope
Postmarketing reports: Cardiac arrhythmias (A-V block, nodal rhythm)

Dermatologic:
Common (1% to 10%): Pruritus
Frequency not reported: Rash, urticaria

Gastrointestinal:
Common (1% to 10%): Dry mouth, nausea (including post-procedural), vomiting
Frequency not reported: Flatulence, increased peristalsis
Postmarketing reports: Bowel cramps, diarrhea

Genitourinary:
Frequency not reported: Urinary frequency

Hypersensitivity:
Frequency not reported: Allergic reactions and anaphylaxis

Musculoskeletal:
Frequency not reported: Muscle cramps and spasms, arthralgia
Postmarketing reports: Muscle weakness

Nervous system:
Common (1% to 10%): Dizziness, headache, postoperative shivering, prolonged neuromuscular blockade, insomnia
Postmarketing reports: Convulsions, drowsiness, dysarthria, fasciculation, loss of consciousness

Ocular:
Frequency not reported: Miosis, visual changes

Other:
Common (1% to 10%): Incision site complication, procedural complication and pain
Frequency not reported: Diaphoresis, flushing, weakness

Renal:
Postmarketing reports: Urinary frequency

Respiratory:
Common (1% to 10%): Pharyngolaryngeal pain, dyspnea, oxygen desaturation (less than 90%)
Frequency not reported: Increased oral, pharyngeal and bronchial secretions, dyspnea, respiratory depression, respiratory arrest, bronchospasm

[#printed] => 1 ) [field_storage] => Array ( [#type_name] => product [#context] => full [#field_name] => field_storage [#post_render] => Array ( [0] => content_field_wrapper_post_render ) [#weight] => 11 [field] => Array ( [#description] => [items] => Array ( [0] => Array ( [#formatter] => default [#node] => stdClass Object *RECURSION* [#type_name] => product [#field_name] => field_storage [#weight] => 0 [#theme] => text_formatter_default [#item] => Array ( [value] => • Store below 30 C° • Protect from light and freezing [format] => 1 [safe] =>

• Store below 30 C°
• Protect from light and freezing

[#delta] => 0 ) [#title] => [#description] => [#theme_used] => 1 [#printed] => 1 [#type] => [#value] => [#prefix] => [#suffix] => [#children] =>

• Store below 30 C°
• Protect from light and freezing

) [#title] => [#description] => [#children] =>

• Store below 30 C°
• Protect from light and freezing

[#printed] => 1 ) [#single] => 1 [#attributes] => Array ( ) [#required] => [#parents] => Array ( ) [#tree] => [#context] => full [#page] => 1 [#field_name] => field_storage [#title] => Storage [#access] => 1 [#label_display] => above [#teaser] => [#node] => stdClass Object *RECURSION* [#type] => content_field [#children] =>

• Store below 30 C°
• Protect from light and freezing

[#printed] => 1 ) [#title] => [#description] => [#children] =>
Storage: 

• Store below 30 C°
• Protect from light and freezing

[#printed] => 1 ) [field_packing] => Array ( [#type_name] => product [#context] => full [#field_name] => field_packing [#post_render] => Array ( [0] => content_field_wrapper_post_render ) [#weight] => 12 [field] => Array ( [#description] => [items] => Array ( [0] => Array ( [#formatter] => default [#node] => stdClass Object *RECURSION* [#type_name] => product [#field_name] => field_packing [#weight] => 0 [#theme] => text_formatter_default [#item] => Array ( [value] => • Injection 0.5mg/1ml: Box of 10 Ampoules • Injection 2.5mg/1ml: Box of 10 Ampoules [format] => 1 [safe] =>

• Injection 0.5mg/1ml: Box of 10 Ampoules
• Injection 2.5mg/1ml: Box of 10 Ampoules

[#delta] => 0 ) [#title] => [#description] => [#theme_used] => 1 [#printed] => 1 [#type] => [#value] => [#prefix] => [#suffix] => [#children] =>

• Injection 0.5mg/1ml: Box of 10 Ampoules
• Injection 2.5mg/1ml: Box of 10 Ampoules

) [#title] => [#description] => [#children] =>

• Injection 0.5mg/1ml: Box of 10 Ampoules
• Injection 2.5mg/1ml: Box of 10 Ampoules

[#printed] => 1 ) [#single] => 1 [#attributes] => Array ( ) [#required] => [#parents] => Array ( ) [#tree] => [#context] => full [#page] => 1 [#field_name] => field_packing [#title] => Packing [#access] => 1 [#label_display] => above [#teaser] => [#node] => stdClass Object *RECURSION* [#type] => content_field [#children] =>

• Injection 0.5mg/1ml: Box of 10 Ampoules
• Injection 2.5mg/1ml: Box of 10 Ampoules

[#printed] => 1 ) [#title] => [#description] => [#children] =>
Packing: 

• Injection 0.5mg/1ml: Box of 10 Ampoules
• Injection 2.5mg/1ml: Box of 10 Ampoules

[#printed] => 1 ) [field_references] => Array ( [#type_name] => product [#context] => full [#field_name] => field_references [#post_render] => Array ( [0] => content_field_wrapper_post_render ) [#weight] => 13 [field] => Array ( [#description] => [items] => Array ( [0] => Array ( [#formatter] => default [#node] => stdClass Object *RECURSION* [#type_name] => product [#field_name] => field_references [#weight] => 0 [#theme] => text_formatter_default [#item] => Array ( [value] => [format] => [safe] => [#delta] => 0 ) [#title] => [#description] => [#theme_used] => 1 [#printed] => 1 [#type] => [#value] => [#prefix] => [#suffix] => ) [#title] => [#description] => [#printed] => 1 ) [#single] => 1 [#attributes] => Array ( ) [#required] => [#parents] => Array ( ) [#tree] => [#context] => full [#page] => 1 [#field_name] => field_references [#title] => References [#access] => 1 [#label_display] => above [#teaser] => [#node] => stdClass Object *RECURSION* [#type] => content_field [#printed] => 1 ) [#title] => [#description] => [#printed] => 1 ) [field_pdf] => Array ( [#type_name] => product [#context] => full [#field_name] => field_pdf [#post_render] => Array ( [0] => content_field_wrapper_post_render ) [#weight] => 14 [field] => Array ( [#description] => [items] => Array ( [0] => Array ( [#formatter] => default [#node] => stdClass Object *RECURSION* [#type_name] => product [#field_name] => field_pdf [#weight] => 0 [#theme] => filefield_formatter_default [#item] => Array ( [fid] => 175 [uid] => 1 [filename] => neostigmine.pdf [filepath] => sites/default/files/pdf/neostigmine.pdf [filemime] => application/pdf [filesize] => 138245 [status] => 1 [timestamp] => 1329487216 [list] => 1 [data] => [i18nsync] => 1 [nid] => 277 [#delta] => 0 ) [#title] => [#description] => [#theme_used] => 1 [#printed] => 1 [#type] => [#value] => [#prefix] => [#suffix] => [#children] => ) [#title] => [#description] => [#children] => [#printed] => 1 ) [#single] => 1 [#attributes] => Array ( ) [#required] => [#parents] => Array ( ) [#tree] => [#context] => full [#page] => 1 [#field_name] => field_pdf [#title] => PDF [#access] => 1 [#label_display] => above [#teaser] => [#node] => stdClass Object *RECURSION* [#type] => content_field [#children] => [#printed] => 1 ) [#title] => [#description] => [#children] => [#printed] => 1 ) [field_related_products] => Array ( [#type_name] => product [#context] => full [#field_name] => field_related_products [#post_render] => Array ( [0] => content_field_wrapper_post_render ) [#weight] => 15 [field] => Array ( [#description] => [items] => Array ( [0] => Array ( [#formatter] => default [#node] => stdClass Object *RECURSION* [#type_name] => product [#field_name] => field_related_products [#weight] => 0 [#theme] => nodereference_formatter_default [#item] => Array ( [nid] => [i18nsync] => 1 [safe] => Array ( ) [#delta] => 0 ) [#title] => [#description] => [#theme_used] => 1 [#printed] => 1 [#type] => [#value] => [#prefix] => [#suffix] => ) [1] => Array ( [#formatter] => default [#node] => stdClass Object *RECURSION* [#type_name] => product [#field_name] => field_related_products [#weight] => 1 [#theme] => nodereference_formatter_default [#item] => Array ( [nid] => [i18nsync] => 1 [safe] => Array ( ) [#delta] => 1 ) [#title] => [#description] => [#theme_used] => 1 [#printed] => 1 [#type] => [#value] => [#prefix] => [#suffix] => ) [2] => Array ( [#formatter] => default [#node] => stdClass Object *RECURSION* [#type_name] => product [#field_name] => field_related_products [#weight] => 2 [#theme] => nodereference_formatter_default [#item] => Array ( [nid] => [i18nsync] => 1 [safe] => Array ( ) [#delta] => 2 ) [#title] => [#description] => [#theme_used] => 1 [#printed] => 1 [#type] => [#value] => [#prefix] => [#suffix] => ) [#title] => [#description] => [#printed] => 1 ) [#single] => 1 [#attributes] => Array ( ) [#required] => [#parents] => Array ( ) [#tree] => [#context] => full [#page] => 1 [#field_name] => field_related_products [#title] => Related Products [#access] => 1 [#label_display] => above [#teaser] => [#node] => stdClass Object *RECURSION* [#type] => content_field [#printed] => 1 ) [#title] => [#description] => [#printed] => 1 ) [#title] => [#description] => [#children] =>
Image: 
Brand Name: 

IPOSTIGMINE®

Dosage Form: 

Injection 0.5mg/1ml - Injection2.5mg/1ml

Pharmacological Category: 

Parasympathomimetic (Cholinergic) Agents

Therapeutic Category: 

Antimyasthenic,Muscle Relaxant

Pregnancy Category: 

category C

Facilitates myoneural junction impulse transmission by inhibiting acetylcholine destruction by cholinesterase.

Pharmacokinetics: 

Rapid absorption, protein binding is 15% to 25% (serum albumin). Neostigmine is metabolized in the liver by microsomal enzymes and undergoes hydrolysis by cholinesterase. It`s is eliminated in urine (50% as unchanged). Half-life is 51 to 90 min and plasma half-life is 47 to 60 min (IV).

Indications: 

Symptomatic control of myasthenia gravis; antidote for nondepolarizing neuromuscular blocking agents after surgery; prevention and treatment of postoperative distention and urinary retention (IV only).

Contraindications: 

Hypersensitivity to anticholinesterases and bromides; mechanical intestinal or urinary obstruction; peritonitis

Precautions: 

• For IV, subcutaneous, or IM administration. Not for intradermal or intra-arterial administration.
• Do not administer if particulate matter or discoloration is noted.
• Patients on IV neostigmine can be transferred to the oral form as soon as it can be tolerated.
• Tablets
• Administer as prescribed. Size of dose (eg, number of tablets) and frequency of administration will be adjusted to provide max relief of myasthenia gravis symptoms.
• Administer without regard to meals. Administer with food if GI upset occurs.
• Larger portions of the daily dose may be given at times when the patient is more prone to fatigue (eg, afternoons, mealtimes).
• Large doses should be avoided in situations where there might be an increased absorption rate from the intestinal tract.
• Ensure that parenteral atropine is available for emergency treatment of cholinergic crisis.

Drug Interactions: 

• Anticholinergic agents (eg, atropine, belladonna)
Intestinal motility may be slowed, increasing neostigmine absorption. Use with caution. Adjust the neostigmine dose as needed.

• Beta-blockers (eg, propranolol)
Severe or prolonged bradycardia may occur because of additive pharmacologic effects. Use with caution. Larger dosages of atropine and sympathomimetic pressor agents may be needed to reverse bradycardia and hypotension.

• Corticosteroids (eg, corticotropin, hydrocortisone)
The effects of neostigmine may be decreased. In addition, the effects of neostigmine may be increased after corticosteroids are discontinued. Provide mechanical respiratory support if needed.

• Drugs that interfere with neuromuscular transmission
May interfere with neuromuscular transmission. Use with caution in myasthenic patients. Monitor the patient and increase the neostigmine dose as needed.

• Kanamycin, streptomycin
Neuromuscular blockade may be enhanced. Use these antibiotics in myasthenic patients only when clearly indicated. Closely monitor the patient. Adjust the neostigmine dose as needed.

• Local/General anesthetics, antiarrhythmic agents (eg, procainamide)
Use with caution in myasthenic patients; may interfere with neuromuscular transmission. Increase the neostigmine dose as needed.

• Quinine
Quinine may antagonize the effects of neostigmine. Avoid using quinine in patients receiving neostigmine for myasthenia gravis.

• Succinylcholine
Neuromuscular blockade produced by succinylcholine may be prolonged. Avoid this combination in the presence of a depolarizing (phase 1) type of neuromuscular blockade. Use with caution if a nondepolarizing (phase 2) type of blockade is present. Provide mechanical respiratory support as needed.

Side Effects: 

Cardiovascular:
Common (1% to 10%): Bradycardia, hypotension, tachycardia
Frequency not reported: Nonspecific EKG changes, cardiac arrest, syncope
Postmarketing reports: Cardiac arrhythmias (A-V block, nodal rhythm)

Dermatologic:
Common (1% to 10%): Pruritus
Frequency not reported: Rash, urticaria

Gastrointestinal:
Common (1% to 10%): Dry mouth, nausea (including post-procedural), vomiting
Frequency not reported: Flatulence, increased peristalsis
Postmarketing reports: Bowel cramps, diarrhea

Genitourinary:
Frequency not reported: Urinary frequency

Hypersensitivity:
Frequency not reported: Allergic reactions and anaphylaxis

Musculoskeletal:
Frequency not reported: Muscle cramps and spasms, arthralgia
Postmarketing reports: Muscle weakness

Nervous system:
Common (1% to 10%): Dizziness, headache, postoperative shivering, prolonged neuromuscular blockade, insomnia
Postmarketing reports: Convulsions, drowsiness, dysarthria, fasciculation, loss of consciousness

Ocular:
Frequency not reported: Miosis, visual changes

Other:
Common (1% to 10%): Incision site complication, procedural complication and pain
Frequency not reported: Diaphoresis, flushing, weakness

Renal:
Postmarketing reports: Urinary frequency

Respiratory:
Common (1% to 10%): Pharyngolaryngeal pain, dyspnea, oxygen desaturation (less than 90%)
Frequency not reported: Increased oral, pharyngeal and bronchial secretions, dyspnea, respiratory depression, respiratory arrest, bronchospasm

Storage: 

• Store below 30 C°
• Protect from light and freezing

Packing: 

• Injection 0.5mg/1ml: Box of 10 Ampoules
• Injection 2.5mg/1ml: Box of 10 Ampoules

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CONTACT US:

Head Office:
Address: No.1, Beastoon Ave., Dr. Fatemi Sq., Tehran1431663135 Iran
Tel: (+98 21)-889 65323
Fax: (+98 21)-889 57056
Factory:
Address: Caspian tamin Pharmaceutical Co., Entrance 1, Rasht Industrial Zone, Rasht, Guilan, Iran
Tel: (+98 131) 338-2511- 8
Fax: (+98 131) 338 – 2517