Introduction

Name

• Neostigmine bromide.
• Neostigmine methylsulfate.

Class of drug

• Anticholinesterase.

Description

Chemical name

• 3-[[(dimethylamino)carbonyl]oxy]-N,N,N-trimethylbenzenaminium.

Molecular formula

• C12H19N2O2.

Physical properties

• Tablets.
• Solution.

Uses

Indications

• Inhibits acetylcholinesterase thereby prolonging the action of acetylcholine. Slower onset but longer duration of action than edrophonium Edrophonium.
• Used to treat acute myasthenic crises Myasthenia gravis when difficulty in breathing and swallowing (megaesophagus) are seen.
• Is also be used to reverse the action of non-depolarizing neuromuscular blocking agents Anesthesia: reversal of neuromuscular blocking agents. Most useful when long acting neuromuscular blocking agents such as pancuronium Pancuronium have been used.
• In diagnosis of myasthenia gravis when edrophonium chloride is unavailable, neostigmine methylsulfate can be used at a dose of 40 µg/kg IM or 20 µg/kg IV. This challenge test is not useful in dogs with focal myasthenia gravis.

Administration

Precautions

Interactions

with other drugs

• Aminoglycosides, clindamycin Clindamycin , lincomycin Lincomycin , polymyxins Polymyxin B and propranolol Propranolol may antagonize the effect of neostigmine.
• Neostigmine enhances the effect of suxamethonium Suxamethonium but antagonises the effect of non-depolarizing muscle relaxants.

Adverse Reactions

Further Reading

Publications

Refereed Papers

• Recent references from PubMed and VetMedResource.

Other sources of information

• Based on Small Animal Formulary. Tennant, Bryn (1999) 3rd edn. Cheltenham: BSAVA.