Tilstigmin Injection
Neostigmine
2.5mg
Tablets India Limited.
| Pack size | 5ml |
|---|---|
| Dispensing mode | |
| Source | |
| Agent | |
| Retail Price | 30.14 NPR |
Available as:
Indications
Tilstigmin Injection is used for:
Myasthenia gravis, Paralytic ileus; Post-op urinary retention, Reversal of nondepolarising neuromuscular blockade
Adult Dose
Parenteral
As metilsulfate
Myasthenia gravis
Adult: 0.5-2.5 mg by IM or SC inj, doses are given at intervals according to response up to a total daily dose of 5-20 mg.
Paralytic ileus and postoperative urinary retention
Adult: 0.5-2.5 mg by SC or IM inj, as required.
Reversal of neuromuscular blockade
Adult: 0.03-0.07 mg/kg by inj over 60 sec, as required.
Not to exceed 0.07 mg/kg or a cumulative total of 5 mg, whichever dose is less Inject by slow IV over at least 1 minute
Oral
Myasthenia gravis
Adult: As neostigmine bromide: 15-30 mg. Doses are given at intervals according to response up to a usual total daily dose of 75-300 mg.
Child Dose
Parenteral
As metilsulfate
Myasthenia gravis
Child: <12 yr 0.2-0.5 mg, repeated at suitable intervals throughout the day.
Paralytic ileus and postoperative urinary retention
Child: 0.125-1 mg by SC or IM inj.
Intravenous
Reversal of neuromuscular blockade
Child: 0.05-0.07 mg/kg by inj over 60 sec, as required.
Oral
Myasthenia gravis
As neostigmine bromide:
Child: <6 yr Initially, 7.5 mg; 6-12 yr Initially, 15 mg. Doses are adjusted according to response up to a usual total daily dose of 15-90 mg.
Intramuscular
Neonatal myasthenia gravis
Child: Initially, 0.1 mg, followed by 0.05-0.25 mg or 0.03 mg/kg 2-4 hrly.
Renal Dose
Renal impairment: Dose adjustment may be required.
Renal impairment: Continuous renal replacement therapy (CRRT): 50% of normal dose.
CrCl (ml/min) Dosage Recommendation
<10 25% of normal dose.
10-50 50% of normal dose.
Administration
Contra Indications
Mechanical GI or urinary tract obstruction, peritonitis.
Precautions
Patient w/ bronchial asthma, CV disorders (e.g. bradycardia, recent MI, hypotension), peptic ulcer disease, vagotonia, epilepsy, parkinsonism, hyperthyroidism. Patient who underwent recent intestinal or bladder surgery. Renal impairment. Childn. Pregnancy and lactation. Monitoring Parameters Monitor ECG, BP and heart rate esp w/ IV use.
Lactation: Unknown if distributed in human breast milk; use caution
Pregnancy-Lactation
Interactions
May reduce effects of anticholinergics. May increase effects of cholinergic agonists. Increased risk of bradycardia with digoxin, diltiazem, verapamil or beta-blockers without intrinsic sympathomimetic activity. Increased muscle weakness and decreased response to anticholinesterases with corticosteroids. May increase effects of depolarising neuromuscular blockers. Effects may be antagonised by drugs with neuromuscular blocking activity e.g. aminoglycosides, clindamycin, colistin, cyclopropane, halogenated inhalational anaesthetics. Effects may be reduced by quinine, chloroquine, hydroxychloroquine, quinidine, procainamide, propafenone, lithium, beta-blockers. Possible additive toxicity with ophthalmic use of anticholinesterases e.g. ecothiopate.
Adverse Effects
Side effects of Neostigmine :
Allergic: Allergic reactions and anaphylaxis
Neurologic: Dizziness, convulsions, loss of consciousness, drowsiness, headache, dysarthria, miosis and visual changes
Cardiovascular: Cardiac arrhythmias (including bradycardia, tachycardia, A-V block and nodal rhythm) and nonspecific EKG changes have been reported, as well as cardiac arrest, syncope and hypotension (predominantly with parenteral dosage form)
Respiratory: Increased oral, pharyngeal and bronchial secretions, and dyspnea; respiratory depression, respiratory arrest and bronchospasm have been reported following the use of the injectable form
Dermatologic: Rash and urticaria
Gastrointestinal: Nausea, emesis, flatulence, and increased peristalsis and salivation
Genitourinary: Urinary frequency
Musculoskeletal: Muscle cramps and spasms, arthralgia
Miscellaneous: Diaphoresis, flushing and weaknes
Potentially Fatal: Anaphylaxis.
Mechanism of Action
Neostigmine reversibly inhibits acetylcholinesterase and thus potentiates the nicotinic and muscarinic effects of acetylcholine. This facilitates the transmission of impulses across myoneural junction.
Note
Tilstigmin 2.5mg Injection manufactured by Tablets India Limited.. Its generic name is Neostigmine. Tilstigmin is availble in Nepal.
Farmaco Nepal drug index information on Tilstigmin Injection is not intended for diagnosis, medical advice or treatment; neither intended to be a substitute for the exercise of professional judgment.