Prostig

• Symptomatic control of myasthenia gravis (when oral therapy is impractical)
• Prevention and treatment of postoperative distention and urinary retention (after mechanical obstruction excluded)
• Reversal of effects of nondepolarizing neuromuscular blocking agents

Reversal of Neuromuscular Blockade:

• Adults: 2-3 mg + atropine 0.6-1.2 mg, slow IV over 1 min; max 5 mg
• Children: 0.05 mg/kg + atropine 0.02 mg/kg, slow IV; max 2.5 mg

Myasthenia Gravis (Adults): 1-2.5 mg IM/SC, up to 5-20 mg daily

Myasthenia Gravis (Neonates): 0.05-0.25 mg IM every 2-4 hours

Urinary Retention Prophylaxis: 0.25 mg SC/IM every 4-6 hours for 2-3 days

Urinary Retention Treatment: 0.5 mg SC/IM

Side Effects (Overdose):

• Cardiac arrhythmias (especially bradycardia)
• Hypotension, cardiac arrest, syncope
• Headache, dizziness, convulsions, coma
• Nausea, vomiting, diarrhea, abdominal cramps
• Muscle cramps, fasciculation, paralysis
• Respiratory depression, bronchospasm
• Allergic reactions (including anaphylaxis)

Use in Pregnancy: Neostigmine may be unsafe during pregnancy (Category C); use only if clearly needed.

• Caution in epilepsy, bronchial asthma, bradycardia, coronary occlusion, vagotonia, hyperthyroidism, cardiac arrhythmias or peptic ulcer
• Keep atropine and antishock medication readily available
• Overdose may cause cholinergic crisis (increasing muscle weakness)
• Important to differentiate from myasthenic crisis
• Caution while driving
• Avoid alcohol