|Reviewed by Dr Carl Kuschel, Robyn Wilkinson, Brenda Hughes, and Leanne Bratton|
Always have Atropine 20 micrograms/kg available to control undue salivation.
Alternatively, Edrophonium may be given (20 micrograms/kg IV followed, after 30 seconds, by 80 micrograms/kg IV if no adverse effect [watch for bradycardia or arrhythmia])
|Maintenance:||IM or SC||
micrograms/kg every 6 to 8 hours.
Higher doses (300 micrograms/kg Q4H may be necessary)
An oral dose of Neostigmine bromide 10-20 times the IM maintenance dose of
Neostigmine methylsulphate every 3 hours.
Other longer acting preparations (e.g. pyridostigmine) may be preferable.
Corticosteroids: decrease in anticholinesterase effect of neostigmine.
Conversely, the anticholinesterase effect may be increased after stopping
Atropine: reversal of muscarinic effect of neostigmine.
Aminoglycoside: neostigmine may reverse the neuromuscular blockade induced by aminoglycoside antibiotics.
Depolarising muscle relaxants (eg. suxamethonium): prolongation of blockade.
Neostigmine prolongs and intensifies the physiological activity of acetylcholine by anticholinesterase activity which is reversible. It is poorly absorbed from the gastrointestinal tract, and CNS penetration is poor. Neostigmine causes vasodilation, increased smooth muscle activity, lacrimation, salivation and increased voluntary muscle tone. It is the preferred agent over edrephonium for the management of neonatal myasthenia gravis, owing to its more prolonged effect (2 to 4 hours), however does have a slower onset of action (20 – 30 minutes).