NEOSTIGMINE METHYLSULPHATE

Neostigmine

Reviewed by Dr Carl Kuschel, Robyn Wilkinson, Brenda Hughes, and Leanne Bratton

October 2001

Management of Neostigmine Administration

Description

Clear colourless 2.5 mg/ml (=2500mcg/ml). pH 4.5 - 6.5.
No proprietary oral preparation available. Refer to Pharmacy.

Prescription

Test doses are charted on the stat page of the prescription chart in micrograms/dose.
Treatment doses are charted on the drug prescription chart in micrograms/dose.

Administration

Oral, IM, SC

Administer at least 30 minutes before feeds.

Observation and Documentation

Monitor for signs of adverse effects and cholinergic crisis.
Ensure atropine is available (reverses effects of neostigmine).
Nurse on cardiorespiratory monitor and assess respiratory function closely.
Ensure resuscitation equipment is available.

Storage

Unopened store at room temperature below 30°C.

Selected References

1	Fisher DM, Cronnelly R, Miller RD, Sharma M. The neuromuscular pharmacology of neostigmine in infants and children. Anaesthesiology 1983; 59:220.
2	Goudsouzian NG, Crone RK, Todres ID. Recovery from pancuronium blockade in the neonatal intensive care unit. Br J Anaesth 1981; 53:1303.
3	Parfitt K (Editor) Martindale: The Extra Pharmacopoeia. (32nd ed). Royal Pharmaceutical Society; 1999: London
4	Northern Neonatal Network. Neonatal Formulary 3. London: BMJ Books,2000
5	Neostigmine Data Sheet. Auckland: Astra Zeneca, 1999
6	Paediatric Formulary. (5^th ed.) Guy’s, St. Thomas’ and Lewisham Hospitals.
7	Paediatric Pharmacopoeia (12^th ed.)Royal Childrens Hospital, Melbourne