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What is the most important information I should know about neostigmine?

Do not use neostigmine if you have a serious stomach condition called peritonitis, or if you have a bladder or bowel obstruction.

Before using neostigmine, tell your doctor if you have asthma, epilepsy or other seizure disorder, a heart rhythm disorder, circulation or blood vessel problems, an overactive thyroid, or a stomach ulcer.

The amount and timing of this medicine is extremely important to the success of your treatment. Carefully follow your doctor’s instructions about how much medicine to take and when to take it.

Your doctor may occasionally change your dose to make sure you get the best results from this medication. You may be asked to keep a daily record of when you took each dose and how long the effects lasted. This will help your doctor determine if your dose needs to be adjusted.

If you need to have any type of surgery, tell the surgeon ahead of time that you are taking neostigmine. You may need to stop using the medicine for a short time.

Warning

Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.

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What is neostigmine?

Neostigmine affects chemicals in the body that are involved in the communciation between nerve impulses and muscle movement.

Neostigmine is used to treat the symptoms of myasthenia gravis.

Neostigmine may also be used for purposes other than those listed in this medication guide.


Precautions

Do not use neostigmine if you have:

  • a serious stomach condition called peritonitis; or
  • a bladder or bowel obstruction.

Before using neostigmine, tell your doctor if you have:

  • asthma;
  • epilepsy or other seizure disorder;
  • a heart rhythm disorder;
  • problems with your blood vessels or circulation;
  • overactive thyroid; or
  • a stomach ulcer.

If you have any of these conditions, you may not be able to use neostigmine, or you may need a dosage adjustment or special tests during treatment.

FDA pregnancy category C. This medication may be harmful to an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant during treatment.

It is not known whether neostigmine passes into breast milk or if it could harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby.

There are no restrictions on food, beverages, or activity while using neostigmine unless your doctor has told you otherwise.

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Instructions

Symptoms of a neostigmine overdose may include extreme muscle weakness, confusion, seizure (convulsions), severe diarrhea, muscle twitching, wheezing, chest tightness, and problems with vision or speech.

Take the missed dose as soon as you remember. If it is almost time for your next dose, skip the missed dose and take the medicine at the next regularly scheduled time. Do not take extra medicine to make up the missed dose.

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Side-effects

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Call your doctor at once if you have any of these serious side effects:

  • severe diarrhea;
  • seizure (convulsions);
  • feeling light-headed, fainting;
  • vision problems; or
  • fast, slow, or uneven heartbeats.

Other less serious side effects are more likely to occur, such as:

  • sweating or urinating more than usual;
  • drooling, watery eyes;
  • warmth or tingly feeling;
  • nausea, vomiting, mild stomach pain;
  • dizziness, drowsiness, weakness, headache;
  • mild itching or skin rash; or
  • muscle cramps, joint pain.

Side effects other than those listed here may also occur. Talk to your doctor about any side effect that seems unusual or that is especially bothersome.

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Interactions

Before taking neostigmine, tell your doctor if you are using any of the following drugs:

  • atropine (Donnatal, and others);
  • belladonna;
  • clidinium (Quarzan);
  • dicyclomine (Bentyl);
  • glycopyrrolate (Robinul);
  • hyoscyamine (Anaspaz, Cystospaz, Levsin);
  • mepenzolate (Cantil);
  • methantheline (Provocholine);
  • methscopolamine (Pamine);
  • propantheline (Pro-Banthine);
  • scopolamine (Transderm-Scop);
  • antibiotics such as neomycin (Mycafradin, Neo-Tab), kanamycin (Kantrex), or streptomycin; or
  • heart rhythm medications such as quinidine (Quinidex, Quinaglute), procainamide (Procan, Pronestyl), disopyramide (Norpace), mexiletine (Mexitil), tocainide (Tonocard), flecainide (Tambocor), propafenone (Rythmol), esmolol (Brevibloc), propranolol (Inderal), metoprolol (Toprol), amiodarone (Cordarone, Pacerone), dofetilide (Tikosyn), sotalol (Betapace).

If you are using any of these drugs, you may not be able to use neostigmine, or you may need dosage adjustments or special tests during treatment.

There may be other drugs not listed that can affect neostigmine. Tell your doctor about all the prescription and over-the-counter medications you use. This includes vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start using a new medication without telling your doctor.

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Disclaimer

Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.

Copyright 1996-2004 Cerner Multum, Inc. Version 2.05. Revision date 8/23/04

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