Neostigmine

Neostigmine is a prescription medicine used for the treatment of Myasthenia Gravis, Urinary Retention or Post-Op Distention, and for reversing the effects of Nondepolarizing Neuromuscular Blockade. 

• Neostigmine is available under the following different brand names: Prostigmin, Bloxiverz

Adult and pediatric dosage

Injectable solution (methylsulfate salt; Bloxiverz)

• 0.5mg/mL
• 1mg/mL

Tablet (bromide salt; Prostigmin)

1. 15 mg

Myasthenia Gravis

Adult dosage

• Acute: 0.5-2.5 mg IV/IM/SC once daily
• Maintenance: 15-375 mg/day orally divided every 6 to 8 hours
• Use injectable with 0.6-1.2 mg atropine IV to counteract muscarinic effects

Pediatric dosage

Use with atropine

• 0.01-0.04 mg/kg IV/IM/SC every 2 to 3 hours or as needed
• 2 mg/kg/day divided every 4 hours orally; no more than 375mg/day

Myasthenia Gravis Diagnosis

Adult dosage

• 0.022 mg/kg IM x1 

Pediatric dosage

Use with atropine

• 0.025-0.04 mg/kg IM x1 

Nondepolarizing Neuromuscular Blockade, Reversal

Adult and pediatric dosage

• 0.03-0.07 mg/kg IV will generally achieve a TOF twitch ratio of 90% within 10-20 minutes of administration
• 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

Post-op Distention or Urinary Retention

Adult dosage

• Prevention: 0.25mg IM after surgery. Repeat every 4 to 6 hours for 2-3 days
• Treatment: 0.5-1 mg IM and up to every 3 hours or as needed (for 5 doses for retention)

Dosage Considerations – Should be Given as Follows: 

• See “Dosages”