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Neostigmine (Neostigmine Methylsulfate) - Summary



Neostigmine Methylsulfate, an anticholinesterase agent.

Neostigmine Methylsulfate Injection, USP is indicated for:

  •   - the symptomatic control of myasthenia gravis when oral therapy is impractical.
  •   - the prevention and treatment of postoperative distention and urinary retention after mechanical obstruction has been excluded.
  •   - reversal of effects of non-depolarizing neuromuscular blocking agents (e.g., tubocurarine, metocurine, gallamine or pancuronium) after surgery.

See all Neostigmine indications & dosage >>


Published Studies Related to Neostigmine

Pre-emptive analgesic and haemodynamic efficacy of combined spinal-epidural neostigmine delivery. [2012]
effects in intra and postoperative period... CONCLUSION: Epidural Neostigmine administration at 8 mcg/kg was found to be a

Comparative clinical study of effect of neostigmine and ketamine for postoperative analgesia. [2011]
The purpose of the study was to evaluate and compare the role of neostigmine and ketamine as an additive to epidural bupivacaine to prolong the duration of postoperative analgesia. A double-blind randomised study was done on 60 adult patients, of both sexes, between 18 and 50 years, belonging to ASA grades I and II, undergoing below umbilical surgeries under epidural anaesthesia...

Less tachycardia in adults when using atropine 0.9 mg compared with 1.2 mg plus neostigmine 2.5 mg. [2008]
CONCLUSION: The authors conclude that 0.9 mg of atropine with 2.5 mg neostigmine

Caudal additives in pediatrics: a comparison among midazolam, ketamine, and neostigmine coadministered with bupivacaine. [2005]
Single-shot "kiddie caudal" with bupivacaine alone is losing popularity because of its duration of 4-8 h. In a prospective randomized double-blind clinical study, we assessed and compared the efficacy of ketamine, midazolam, and neostigmine coadministered with bupivacaine in a caudal epidural to provide intraoperative and postoperative pain relief...

Postoperative analgesic effect of epidural neostigmine and plasma cortisol and IL-6 responses. [2004]
pain status... CONCLUSIONS: The preincisional epidural neostigmine transiently suppresses the

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Clinical Trials Related to Neostigmine

Comparative Study of Sugammadex Versus Neostigmine for Reversal of Neuromuscular Blockade in Morbidly Obese Patients [Recruiting]
Postoperative residual curarization in the post anaesthesia unit has been associated to complications involving respiratory function and impaired laryngeal and pharyngeal muscles' function. Speed of reversal of neuromuscular blockade after administration of sugammadex versus neostigmine has been studied, but up to date no data are available concerning continuous acceleromyography monitoring of adductor pollicis and corrugator supercilii in morbidly obese patients undergoing weight loss surgery. The investigators' aim in this prospective, double-blinded study was to compare train of four ( TOF ) values, the presence or absence of clinical criteria of postoperative residual curarization , the dose requirements and the side effects of sugammadex and neostigmine for the reversal of rocuronium induced neuromuscular blockade in patients undergoing laparoscopic or open surgery for morbid obesity.

Comparison of Rocuronium and Org 25969 With Cisatracurium and Neostigmine (19.4.310)(P05931)(COMPLETED) [Completed]
The purpose of this study was to demonstrate in adult patients a faster recovery from a neuromuscular block with 2. 0 mg/kg Org 25969 (sugammadex) after rocuronium as compared to 50 ug/kg neostigmine after cisatracurium when administered at reappearance of T2

Electromyographic Activity of the Respiratory Muscles During Neostigmine or Sugammadex Enhanced Recovery After Neuromuscular Blockade [Not yet recruiting]
It was recently shown that neostigmine reversal was associated with increased atelectasis and that high-dose neostigmine was associated with longer postoperative length of stay and with an increased incidence of pulmonary edema and reintubation. These study results were consistent with findings from a previous epidemiological study which revealed an absence of beneficial effects of neostigmine on postoperative oxygenation and reintubation. In our previous study, the effects of neostigmine / glycopyrrolate and sugammadex on the electromyographic activity of the diaphragm showed beneficial effects for sugammadex. This could be explained by a possible effect on neuromuscular transmission at the muscle level, but can also be explained by a neostigmine-induced decrease in total nerve activity. In a study in cats, neostigmine has been shown to reduce efferent phrenic nerve activity. The investigators aim to show a difference in phrenic nerve activity between neostigmine and sugammadex, administered alone or in combination, in healthy male volunteers.

Functional Respiratory Imaging After Neostigmine or Sugammadex [Completed]
The use of neuromuscular blocking agents (NMBAs) is still associated with postoperative pulmonary complications. The investigators rely on acceleromyography (AMG) of a peripheral nerve/muscle to assess the patients' breathing capability at the end of surgery. It is possible that respiratory complications after surgery (e. g. desaturation and atelectasis) are related to the lack of diaphragm activity. A previous trial by our study group links the use of sugammadex, a novel selective relaxant binding agent (SRBA) for reversal of neuromuscular blockade, to an increase in diaphragm electrical activity, compared to reversal with neostigmine. Our hypothesis is that by making nicotinergic acetylcholine receptors free from rocuronium in the diaphragmatic neuromuscular junctions, instead of increasing the amount of acetylcholine (like neostigmine does), sugammadex will result in a better neuromuscular coupling. This may have its subsequent effects on the central control of breathing, influencing the balance between intercostal and diaphragm activity. The investigators now propose a study in rats, where the investigators will use Functional Respiratory Imaging (FRI, property of FluidDA n. v., Groeningenlei 132, B-2550 Kontich) to assess regional lung ventilation after sugammadex, neostigmine or spontaneous reversal. The images obtained through micro-CT scans allow us to accurately reconstruct airway morphology in the free-breathing rat. It will provide us with new insights into breathing physiology after reversal of neuromuscular blockade.

Sugammadex Versus Neostigmine in Patients With Liver Cirrhosis Undergoing Liver Resection [Recruiting]
Liver cirrhosis is a progressive disease characterized by loss of functional hepatocytes that substantially affects drug pharmacokinetics. Rocuronium onset time is longer and recovery time from it is prolonged in cirrhotic patients than in those with normal liver function. This randomized controlled study is designed to compare the pharmacodynamic profiles of sugammadex and neostigmine when used for the antagonism of moderate degree of rocuronium-induced neuromuscular block in cirrhotic patients undergoing liver resection and in patients with preoperative normal liver functions undergoing liver resection.

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Reports of Suspected Neostigmine Side Effects

Acute Respiratory Distress Syndrome (5)Acute Respiratory Failure (5)Chylothorax (3)Sepsis (3)Drug Interaction (2)Erythema (2)Pulmonary Granuloma (2)Hypoxia (2)Pulmonary Oedema (2)Atrioventricular Dissociation (2)more >>

Page last updated: 2013-02-10

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