Neostigmine

Provider Level

RN/Paramedic

Class

Acetylcholinesterase inhibitor

Mechanism of Action

Reversibly inhibits acetylcholinesterase, preventing the breakdown of acetylcholine, thereby increasing its concentration at the neuromuscular junction and autonomic ganglia.

Indications

Reversal of non-depolarizing neuromuscular blockade, management of myasthenia gravis, prevention and treatment of postoperative distention and urinary retention.

Contraindications

Peritonitis, mechanical intestinal or urinary tract obstruction, known hypersensitivity to the drug or bromides.

Routes

IM, SQ, IV, IO

Onset / Duration

Onset: 10 to 30 minutes (IM), 1 to 20 minutes (IV). Duration: 2 to 4 hours.

Adverse Effects

Bradycardia, hypotension, increased salivation and bronchial secretions, bronchospasm, nausea, vomiting, abdominal cramps, diarrhea, muscle fasciculations, weakness, seizures.

Precautions & Interactions

May cause profound bradycardia or dysrhythmias; typically co-administered with an anticholinergic agent like atropine or glycopyrrolate. Use with caution in patients with asthma, cardiovascular disease, epilepsy, hyperthyroidism, or peptic ulcer disease.

Special Considerations

Requires continuous ECG and vital sign monitoring. Atropine must be immediately available to treat severe cholinergic reactions. Do not use to reverse depolarizing neuromuscular blocking agents like succinylcholine, as it may prolong their effects.