From the Guidelines
Indications for Neostigmine
Neostigmine is primarily indicated for the reversal of non-depolarizing neuromuscular blockade after surgery, with a typical intravenous dose of 0.04 mg/kg 1, usually administered with atropine 0.02 mg/kg to prevent muscarinic side effects.
- The decision to administer neostigmine should be based on the visual or tactile evaluation of responses to Train of four (TOF) stimulation at the adductor pollicis, with neostigmine administered when four responses to TOF stimulation are present 1.
- Neostigmine works by increasing acetylcholine concentration in the synaptic cleft, allowing for the reversal of non-depolarizing muscle relaxants 1.
- The efficacy of neostigmine in reversing neuromuscular blockade is dependent on the degree of blockade prior to administration, with four visual or tactile TOF responses being the minimum required for effective reversal 1.
- Neostigmine may also be used for other indications, but the provided evidence primarily supports its use in the reversal of non-depolarizing neuromuscular blockade. Key points to consider when administering neostigmine include:
- Monitoring of TOF responses to determine the optimal time for neostigmine administration
- Administration of atropine to prevent muscarinic side effects
- The dose of neostigmine required for effective reversal, typically 0.04 mg/kg 1
From the FDA Drug Label
Neostigmine methylsulfate injection is a cholinesterase inhibitor indicated for the reversal of the effects of non-depolarizing neuromuscular blocking agents after surgery. Neostigmine methylsulfate injection, a cholinesterase inhibitor, is indicated for the reversal of the effects of non-depolarizing neuromuscular blocking agents (NMBAs) after surgery (1). The indications for Neostigmine are:
From the Research
Indications for Neostigmine
The indications for Neostigmine are as follows:
- Myasthenia gravis: Neostigmine has been shown to be effective in treating myasthenia gravis, a chronic autoimmune disorder characterized by weakness and fatigue in skeletal muscles 3, 4, 5.
- Reversal of non-depolarizing neuromuscular blockade: Neostigmine is used to reverse the effects of non-depolarizing neuromuscular blocking agents, which are used to relax muscles during surgery 6, 7.
- Treatment of postoperative residual paralysis and respiratory complications: Neostigmine can be used to treat postoperative residual paralysis and respiratory complications in patients with myasthenia gravis 7.
Administration Routes
Neostigmine can be administered through various routes, including:
- Intravenous (i.v.) administration: Neostigmine can be administered intravenously to rapidly reverse non-depolarizing neuromuscular blockade 6.
- Intranasal (i.n.) administration: Neostigmine can be administered intranasally, which has been shown to be effective in treating myasthenia gravis 3, 4.
- Oral administration: Neostigmine can be administered orally, but this route may have variable absorption and may not be as effective as other routes 4.