Active Ingredient: Neostigmine
For this indication, competent medicine agencies globally authorize below treatments:
For:
Subcutaneous, between 1 milligrams neostigmine and 2.5 milligrams neostigmine, every 2 to 4 hours.
1-2.5 mg neostigmine repeated at suitable intervals throughout the day (usual total daily dose in adults is 5-20 mg).
For:
Oral, between 75 milligrams neostigmine and 100 milligrams neostigmine, divided daily.
Doses of 15-30 mg by mouth are given at intervals throughout the day when maximum strength is needed (for example, on rising and before mealtimes). The usual duration of action of a dose is two to four hours.
The total daily dose is usually in the range of 75-300 mg but doses higher than these may be needed by some patients.
When relatively large doses of neostigmine are taken by myasthenic patients, it may be necessary to give atropine or other anticholinergic drugs to counteract the muscarinic effects. It should be noted that the slower gastro-intestinal motility caused by these drugs may affect the absorption of oral neostigmine.
In all patients the possibility of ‘cholinergic crisis’, due to overdosage of neostigmine, and its differentiation from ‘myasthenic crisis’, due to increased severity of disease, must be borne in mind. Both types of crisis are manifested by increased muscle weakness, but whereas myasthenic crisis may require more intensive anticholinesterase treatment, cholinergic crisis calls for immediate discontinuation of this treatment and institution of appropriate supportive measures, including respiratory assistance.
For:
Intravenous, between 5 milligrams neostigmine and 20 milligrams neostigmine, divided daily.
1-2.5 mg neostigmine repeated at suitable intervals throughout the day (usual total daily dose in adults is 5-20 mg).
For:
Intramuscular, between 5 milligrams neostigmine and 20 milligrams neostigmine, divided daily.
1-2.5 mg neostigmine repeated at suitable intervals throughout the day (usual total daily dose in adults is 5-20 mg).
For:
Regimen A: In case that patient age in years is ≤ 6, oral, 7.5 milligrams neostigmine, once daily. Afterwards, in case that patient age in years is ≤ 6, oral, between 15 milligrams neostigmine and 90 milligrams neostigmine, divided daily.
Regimen B: In case that patient age in years is ≥ 6 and patient age in years is ≤ 12, oral, 15 milligrams neostigmine, once daily. Afterwards, in case that patient age in years is ≥ 6 and patient age in years is ≤ 12, oral, between 15 milligrams neostigmine and 90 milligrams neostigmine, divided daily.
Children under 6 years old should receive an initial dose of 7.5 mg of neostigmine; children 6-12 years old should receive 15 mg. Dosage requirements should be adjusted according to the response but are usually in the range of 15-90 mg orally per day.
For:
Intravenous, in total between 0.2 milligrams neostigmine and 0.5 milligrams neostigmine,.
For:
Intramuscular, in total between 0.2 milligrams neostigmine and 0.5 milligrams neostigmine,.
For:
Subcutaneous, in total between 0.2 milligrams neostigmine and 0.5 milligrams neostigmine,.
For:
Regimen A: Intramuscular, 0.1 milligrams neostigmine, one dose. Afterwards, intramuscular, 0.03 milligrams neostigmine per kilogram of body weight, once every 2 to 4 hours.
Regimen B: Intramuscular, 0.1 milligrams neostigmine, one dose. Afterwards, intramuscular, between 0.05 milligrams neostigmine and 0.25 milligrams neostigmine, once every 2 to 4 hours.
150 micrograms/kg neostigmine every 6–8 hours, to be given 30 minutes before feeds, then increased if necessary up to 300 micrograms/kg every 4 hours. Because of the self-limiting nature of the disease in neonates, the daily dosage should be reduced until the drug can be withdrawn.
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