What are the indications for Neostigmine (neostigmine)?

From the Guidelines

Neostigmine is indicated for the reversal of non-depolarizing muscle relaxants after surgery, with a typical dose of 0.5-2.5 mg intravenously 1.

Key Indications

• Reversal of non-depolarizing muscle relaxants after surgery
• Treatment of myasthenia gravis to improve muscle strength and reduce muscle fatigue, although pyridostigmine bromide is often the first-line treatment for this condition 1

Important Considerations

• The dose and duration of treatment should be individualized and monitored closely by a healthcare professional 1
• A spontaneous TOF ratio of > 0.2 should occur before neostigmine administration, and a TOF ratio of more than 0.9 should be obtained before extubation 1
• Selective relaxant binding agents (SRBA) such as sugammadex may be preferred over neostigmine for reversal of non-depolarizing muscle relaxants due to their more predictable and rapid reversal 1
• Neostigmine may also be used to treat urinary retention and abdominal distension due to postoperative ileus, although this is not a primary indication 1

From the FDA Drug Label

Neostigmine methylsulfate injection, a cholinesterase inhibitor, is indicated for the reversal of the effects of non-depolarizing neuromuscular blocking agents (NMBAs) after surgery Neostigmine methylsulfate injection is a cholinesterase inhibitor indicated for the reversal of the effects of non-depolarizing neuromuscular blocking agents after surgery

The indications for Neostigmine are:

• Reversal of the effects of non-depolarizing neuromuscular blocking agents (NMBAs) after surgery 2 2

From the Research

Indications for Neostigmine

The indications for Neostigmine are as follows:

• Reversal of non-depolarising neuromuscular blockade in general anaesthesia 3
• Symptomatic treatment of myasthenia gravis 3, 4, 5
• Treatment of myasthenic patients with irregular absorption of oral doses 5
• Early morning treatment and temporary effect in myasthenic patients 5
• Bulbar impairment and emergencies in myasthenic patients 5

Administration Routes

Neostigmine can be administered through various routes, including:

• Intravenous (i.v.) 3, 6, 4
• Intranasal (i.n.) 4, 5
• Oral 3, 5, 7
• Intramuscular (i.m.) 7

Clinical Uses

Neostigmine has been shown to be effective in:

• Improving muscle strength and respiratory function in myasthenic patients 4, 5
• Reversing non-depolarising neuromuscular blockade in awake healthy volunteers 6
• Providing a quicker onset of action and a more adaptable dosage regimen than oral neostigmine 4, 5