Neostigmine is used to treat muscle weakness due to myasthenia gravis, non-obstructive urinary retention after surgery, and as an antidote to tobocurarin and other non-depolarizing neuromuscular blocking drugs.
Mechanism of action Ipostigmin
This drug prevents the hydrolysis of acetylcholine by acetylcholinesterase and thus facilitates the transmission of nerve impulses from the nerve-muscle junction. Neostigmine can also affect autonomic ganglion cells and neurons in the CNS. It also reduces gastric contraction after surgery by increasing the stimulation and tone of the stomach muscles. In addition, prolonging the effect of acetylcholine on the end plate increases muscle strength in myasthenia gravis patients, while this effect is not seen in other patients.
Neostigmine is rapidly absorbed after intramuscular injection. It is metabolized in plasma and liver and excreted by the kidneys.
prohibited usage Ipostigmin
- In case of mechanical obstruction of the intestine or urinary tract, it should be prescribed with great caution.
- It should be used with caution after surgery, as it may aggravate respiratory problems caused by postoperative pain, relief, discharge retention, or atelectasis.
- Use with caution in the following cases: asthma, bradycardia, recent myocardial infarction, Parkinson’s, vagus denervation, gastric ulcer, renal discomfort.
side effects Ipostigmin
Common side effects include diarrhea, nausea or vomiting, cramps or stomach pain, abnormal sweating, and salivation.
Drug interactions Ipostigmin
The neuromuscular blockade is exacerbated by systemic aminoglycosides, hydrocarbon inhaled anesthetics, injectable local anesthetics, and clindamycin. Concomitant use with other cholinesterase inhibitors may lead to additional intoxication. Concomitant use of depolarizing neuromuscular blocking drugs such as succinylcholine may reduce their effect. Concomitant use of procaine amidia quinidine with this drug may counteract neuromuscular blocking activity or its antimuscarinic side effect.
Taking this medicine with food or milk reduces the possibility of side effects. If the drug is administered intravenously, it is recommended to administer a dose of 1.2 – 0.6 mg of atropine before or at the same time as neostigmine to counteract the muscarinic side effects of the drug.
Treatment of muscle weakness due to myasthenia gravis: Adults: 15 mg every 3-4 hours to start treatment for myasthenia gravis according to the patient’s needs and then 150 mg for 24 hours at intervals based on the patient’s response Children: 2 mg / kg or 60 mg / m در per day in 6-8 divided doses. Injectable – Adults: For the treatment of myasthenia gravis, 0.5 mg is initially prescribed and subsequent values are adjusted based on the patient’s response. 0.5-2 mg as an antidote is given slowly and subsequent amounts as needed up to a total of 5 mg are prescribed. Children: 0.04 – 0.01 mg / kg is given every 2-3 hours intramuscularly or subcutaneously. As an antidote, 0.04 mg / kg of the drug is injected intravenously with 0.02 mg / kg atropine. For the diagnosis of myasthenia gravis, 0.0 mg / kg or 1 mg / kg is given intramuscularly or 0.02 mg / kg or 0.5 mg / m³ intravenously. Prevention of urinary retention or reduction of gastrointestinal contraction after surgery: 0.25 mg immediately after the operation is injected intramuscularly or subcutaneously and this amount is repeated every 4-6 hours for 2-3 days. For the treatment of urinary retention, 0.5 mg is injected intramuscularly or subcutaneously and repeated every three hours for at least five times after emptying the bladder.
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