From the FDA Drug Label
• Hypersensitivity to neostigmine • Peritonitis or mechanical obstruction of the intestinal or urinary tract
The contraindications for intravenous neostigmine for colonic ileus are:
- Hypersensitivity to neostigmine
- Peritonitis or mechanical obstruction of the intestinal or urinary tract 1 These contraindications are also supported by another study 1.
From the Research
Intravenous neostigmine is contraindicated in patients with mechanical bowel obstruction, intestinal perforation, peritonitis, recent bowel anastomosis, severe bradycardia, heart block, bronchospasm, active bronchial asthma, and hypersensitivity to the drug or its components when treating colonic ileus. The use of intravenous neostigmine for colonic ileus is supported by several studies, including 2, which highlights the efficacy and safety of neostigmine in treating ileus, acute colonic pseudo-obstruction, or refractory constipation. However, it is crucial to consider the contraindications to ensure safe administration. Some of the key contraindications include:
- Mechanical bowel obstruction
- Intestinal perforation
- Peritonitis
- Recent bowel anastomosis
- Severe bradycardia
- Heart block
- Bronchospasm
- Active bronchial asthma
- Hypersensitivity to the drug or its components Relative contraindications may also include recent myocardial infarction, renal impairment, and pregnancy, as noted in various studies such as 3 and 4. When administering IV neostigmine, typically 2-2.5 mg over 3-5 minutes, patients should be closely monitored for adverse effects, including bradycardia, bronchospasm, increased secretions, and abdominal pain, as reported in studies like 5 and 6. Atropine should be immediately available to counteract severe cholinergic side effects. The mechanism behind these contraindications relates to neostigmine's action as an acetylcholinesterase inhibitor, which increases acetylcholine levels at parasympathetic nerve endings, potentially causing dangerous parasympathetic overstimulation in vulnerable patients, as discussed in 3.