Neostigmine Methylsulfate Injection USP 0.5mg/1ml
- Name of the medicinal product
Neostigmine Methylsulfate Injection USP 0.5mg in 1ml Taj Pharma
Neostigmine Methylsulfate Injection USP 2mg in 1ml Taj Pharma
Neostigmine Methylsulfate Injection USP 5mg in 10ml Taj Pharma
Neostigmine Methylsulfate Injection USP 10mg in 10ml Taj Pharma
- Qualitative and quantitative composition
Each ml contains 0.5mg of Neostigmine Methylsulfate.
Each ml contains 2mg of Neostigmine Methylsulfate.
Each 10ml contains 5mg of Neostigmine Methylsulfate.
Each 10ml contains 10mg of Neostigmine Methylsulfate.
For a full list of excipients, see section 6.1.
- Pharmaceutical form
Sterile Injection
- Clinical particulars
4.1 Therapeutic indications
Indications
Myasthenia Gravis, antagonist to non-depolarizing neuromuscular blockade, Paralytic Ileus, Post-operative Urinary Retention; Paroxysmal Supraventricular Tachycardia.
Routes of Administration
Neostigmine Methylsulfate may be administered by IV, IM or SC injection.
4.2 Posology and method of administration
Neostigmine Methylsulfate should be given very slowly by the IV route. A syringe of Atropine Sulfate should always be available to counteract severe cholinergic reactions should they occur.
Myasthenia Gravis
1 – 2.5mg by IM or SC injection at intervals throughout the day, when maximum strength is needed. The usual duration of action of a dose is two to four hours. The total daily dose is usually 5 – 20mg by injection but higher doses may be needed by some patients.
Neonatal Myasthenia Gravis may be treated with 0.1mg Neostigmine intramuscularly initially. Thereafter, the dose must be titrated individually. But is usually 0.05 – 0.25mg IM or 0.03mg/kg IM, every two – four hours. Because of the self-limiting nature of the disease in neonates, the daily dosage should be reduced until the drug can be withdrawn.
Older Children: (Under 12 years of age)
May be given 0.2 – 0.5mg by injection as required. Dosage requirements should be adjusted according to the response of the patient.
Antagonist to Non-depolarizing Neuromuscular Blockade
Reversal of Neuromuscular blockade with Neostigmine should not be attempted unless there is spontaneous recovery from paralysis.
Adults and Children
A single dose of Neostigmine 0.05 – 0.07 mg/kg body-weight and Atropine 0.02 – 0.03 mg/kg body weight, by slow IV injection over one minute is usually adequate for complete reversal of Non-depolarizing Muscle Relaxants within 5 – 15 minutes. The maximum recommended dose of Neostigmine in adults is 5mg and in children 2.5mg.
Atropine and Neostigmine may be given simultaneously, but in patients with Bradycardia, the pulse rate should be increased to 80 per minute with Atropine before administering Neostigmine.
Other Indications
Adults: 0.5 – 2.5mg Neostigmine Methylsulfate by SC or IM injection.
Children: 0.125 – 1mg by injection. Doses may be varied according to the individual needs of the patient.
Elderly: There are no specific dosage recommendations for Neostigmine Methylsulfate in the elderly.
4.3 Contraindications
Use of neostigmine is contraindicated in patients with hypersensitivity to neostigmine or to any of the excipients in this injection.
Neostigmine should not be administered to patients with mechanical obstruction of gastrointestinal or urinary tracts, peritonitis or doubtful bowel viability.
Neostigmine should not be used in conjunction with depolarising muscle relaxants such as suxamethonium as neuromuscular blockade may be potentiated.
4.4 Special warnings and precautions for use
Neostigmine should be used with extreme caution in patients with asthma as the parasympathomimetic action of neostigmine may cause bronchoconstriction.
Bradycardia, with the potential for progression to asystole, may occur in patients receiving neostigmine by intravenous injection unless atropine is given simultaneously. Extreme caution should be employed when treating patients with pre-existing bradycardia, cardiac arrhythmia or recent coronary occlusion.
Patients who are hyperreactive to neostigmine experience a severe cholinergic reaction to the drug. Atropine sulfate should always be available as an antagonist for the muscarinic effects of neostigmine.
Neostigmine should be used with caution in patients with epilepsy, vagotonia, hyperthyroidism, peptic ulceration or parkinsonism.
Administration of anticholinesterase agents to patients with intestinal anastomoses may produce rupture of the anastomosis or leakage of intestinal contents.
Elderly
Although there are no specific dosage requirements in the elderly, these patients may be more susceptible to dysrhythmias than younger patients.
Inhaled anaesthetics
Neostigmine Methylsulfate should not be given during cyclopropane or halothane anaesthesia; although it may be used after withdrawal of these agents.
4.5 Interaction with other medicinal products and other forms of interaction
Neuromuscular Blocking Agents
Neostigmine effectively antagonises the effect of Non-depolarizing muscle relaxants (e.g. Tubocurarine, Gallamine or Pancuronium) and this interaction is used to therapeutic advantage to reverse muscle relaxation after surgery. Neostigmine does not antagonise, and it may in fact prolong, the phase I block of depolarizing muscle relaxants such as Succinylcholine.
Other Drugs
Atropine antagonises the muscarinic effects of Neostigmine, the interaction is utilised to counteract the muscarinic symptoms of the Neostigmine toxicity.
Anticholinesterase agents are sometimes effective in reversing Neuromuscular Block induced by Aminoglycoside Antibiotics. However, Aminoglycoside Antibiotics and other drugs that interfere with Neuromuscular transmission should be used cautiously, if at all, in patients with Myasthenia Gravis and the dose of Neostigmine may have to be adjusted accordingly.
4.6 Fertility, pregnancy and lactation
The use of Neostigmine Methylsulfate during pregnancy or lactation has not been established. Although the possible hazards to mother and child must be weighed against the potential benefits in every case. Experience with Myasthenia Gravis has revealed no untoward effect of the drug on the course of pregnancy. As the severity of Myasthenia Gravis often fluctuates considerably, particular care is required to avoid cholinergic crisis due to overdosage of Neostigmine.
Only negligible amounts of Neostigmine Methylsulfate are excreted in breast milk. Nevertheless, attention should be paid to possible effects on the breast-feeding infant.
4.7 Effects on ability to drive and use machines
Not applicable.
4.8 Undesirable effects
Adverse effects of Neostigmine are chiefly those of exaggerated response to parasympathetic stimulation.
| System Organ Class | Adverse reaction | Frequency |
| Immune system disorders | Hypersensitivity, angioedema, anaphylactic reaction. | Not known |
| Nervous system disorders | Cholinergic syndrome, especially at high doses. In patients with myasthenia gravis, cholinergic crisis may be difficult to distinguish from myasthenia crisis (see section 4.9). | Not known |
| Eye disorders | Miosis, lacrimation increased | Not known |
| Cardiac disorders | Bradycardia, decreased cardiac conduction, in severe cases possibly leading to heart block or cardiac arrest | Not known |
| Vascular disorders | Hypotension | Not known |
| Respiratory, thoracic or mediastinal disorders | Increased bronchial secretion, bronchospasm | Not known |
| Gastrointestinal disorders | Nausea, vomiting, diarrhoea, abdominal cramps, salivary hypersecretion. Increased intestinal motility may result in involuntary defecation. | Not known |
| Skin and subcutaneous tissue disorders | Hyperhidrosis | Not known |
| Musculoskeletal, connective tissue and bone disorders | Muscle spasms | Not known |
| Renal and urinary disorders | Urinary incontinence | Not known |
Reporting of suspected adverse reactions
Reporting suspected adverse reactions after authorisation of the medicinal product is important. It allows continued monitoring of the benefit/risk balance of the medicinal product.
4.9 Overdose
Symptoms
Neostigmine Methylsulfate overdosage may include Cholinergic Crisis, which is characterised by nausea, vomiting, diarrhoea, excessive salivation and sweating, increased bronchial secretions, miosis, bradycardia or tachycardia, cardiospasm, bronchospasm, incoordination, muscle cramps, fasciculation and paralysis. Extremely high doses may produce CNS symptoms of agitation, fear or restlessness. Death may result from cardiac arrest or respiratory paralysis and pulmonary oedema. In patients with Myasthenia Gravis, in whom overdosage is most likely to occur, fasciculation and adverse parasympathomimetic effects may be mild or absent making cholinergic crisis difficult to distinguish from Myasthenia crisis.
Treatment
Maintenance of adequate respiration is of primary importance. Tracheostomy, Bronchial aspiration and postural drainage may be required; Respiration can be assisted mechanically or with oxygen, if necessary.
Neostigmine Methylsulfate should be discontinued immediately and 1 – 4mg of Atropine Sulfate administered IV. Additional doses of Atropine may be given every 5 – 30 minutes as needed to control muscarinic symptoms. Atropine overdosage should be avoided as tenacious secretions and bronchial plugs may result.
- Pharmacological properties
5.1 Pharmacodynamic properties
Neostigmine inhibits cholinesterase activity and prolongs and intensifies the muscarinic and nicotinic effects of acetylcholine. The anticholinesterase actions of Neostigmine are reversible. It is used mainly for its action on skeletal muscle and less frequently to increase the activity of smooth muscle. Neostigmine is used in the treatment of Myasthenia Gravis.
5.2 Pharmacokinetic properties
Neostigmine is a quaternary ammonium compound and is poorly absorbed from the gastrointestinal tract. Following parenteral administration as the methylsulfate, neostigmine is metabolised partly by hydrolysis of the ester linkage and is excreted in the urine both as unchanged drug and as metabolites. The half-life of neostigmine is only one to two hours.
5.3 Preclinical safety data
No further information other than that which is included in the Summary of Product Characteristics.
- Pharmaceutical particulars
6.1 List of excipients
Sodium chloride
Water for Injections
6.2 Incompatibilities
Neostigmine may be diluted with Water for Injections. Stability of the injection cannot be guaranteed once it has been diluted.
6.3 Shelf life
36 Months.
6.4 Special precautions for storage
Protect from light and store at less than 25°C.
6.5 Nature and contents of container
The ampoules are packed in cartons to contain 10 ampoules.
6.6 Special precautions for disposal and other handling
Use as directed by a physician.
If only part used discard the remaining solution.
- Manufactured in India by:
TAJ PHARMACEUTICALS LTD.
Mumbai, India
Unit No. 214.Old Bake House,
Maharashtra chambers of Commerce Lane,
Fort, Mumbai – 400001
at:Gujarat, INDIA.
Customer Service and Product Inquiries:
1-800-TRY-FIRST (1-800-222-434 & 1-800-222-825)
Monday through Saturday 9:00 a.m. to 7:00 p.m. EST
E-mail: tajgroup@tajpharma.com
Neostigmine Methylsulfate Injection USP 0.5mg/1ml, 2mg/ml, 5mg/10ml, 10mg/10ml
Package Leaflet: Information for the user
- Read all of this leaflet carefully before you start using this medicine because it contains important information for you.
- Keep this leaflet. You may need to read it again.
- If you have any further questions, please ask your doctor or your pharmacist
What is in this leaflet
- What Neostigmine Methylsulfate Injection is and what it is used for
- What you need to know before you are given Neostigmine Methylsulfate Injection
- How to use Neostigmine Methylsulfate Injection
- Possible side effects
- How to store Neostigmine Methylsulfate Injection
- Contents of the pack and other information
- What Neostigmine Methylsulfate Injection is and what it is used for
Neostigmine injection belongs to a group of medicines used to:
- Treat abnormally tired and weak muscles (myasthenia gravis).
- Reverse the effects of muscle relaxants.
- Improve movement in the small intestine.
- Reduce urine retention after surgical procedures.
- What you need to know before you are given Neostigmine Methylsulfate Injection
Do not use Neostigmine Methylsulfate Injection if you:
- are allergic to neostigmine or any of the other ingredients in this medicine (listed in section 6).
- have an intestinal obstruction or cannot urinate.
- have peritonitis (an infection or inflammation of the outer layer of your stomach or intestines).
- have a condition where your bowel may no longer be functioning.
- you are receiving certain muscle relaxants (e.g. Suxamethonium).Warning and precautions
Talk to your doctor or nurse before being given the injection if you have:
- asthma
- epilepsy
- a slow pulse
- any heart disease
- vagotonia (you may suffer from sweating, constipation and involuntary movements)
- an overactive thyroid gland
- a stomach ulcer
- Parkinson’s Disease
- an anastomosis (an opening created by surgery, trauma, or disease) in your intestine
- a controlled low sodium diet (this medicinal product contains approximately 3.54 mg sodium per ml)Other medicines and Neostigmine Methylsulfate Injection
Tell your doctor or pharmacist if you are taking, have recently taken or might take any other medicines. This is especially important with the following medicines as they may interact with your Neostigmine Methylsulfate Injection :
- you are receiving antibiotics known as aminoglycosides.Pregnancy or breast feeding
If you are pregnant or breast-feeding, think you may be pregnant or are planning to have a baby, ask your doctor or pharmacist for advice before taking this medicine.
Driving and using machines
You should not drive or use machinery if you are affected by the administration of Neostigmine Methylsulfate Injection.
- How to use Neostigmine Methylsulfate Injection
Your nurse or doctor will give you the injection. Your doctor will decide the correct dosage for you and how and when the injection will be given.
Since the injection will be given to you by a doctor or nurse, it is unlikely that you will be given too much. If you think you have been given too much, you must tell the person giving you the injection. - Possible side effects
Like all medicines, this medicine can cause side effects, although not everybody gets them.
Contact a doctor right away if you notice any of the following symptoms – you may need urgent medical treatment:
- Swelling of the face, lips or throat which makes it difficult to swallow or breathe, rash, itching, hives and dizziness. This could be a sign of an angioedema or a severe allergic reaction (frequency not known, cannot be estimated from the available data).
The following side effects have also been reported:
You may (frequency not known, cannot be estimated from the available data)
- feel or actually be sick
- produce more saliva than usual
- produce more tears than usual
- suffer from bronchial spasm and increased bronchial secretion
- suffer from diarrhoea and stomach cramps
- have constricted (pin-point) pupils in your eye
- suffer from urinary incontinence (you pass urine when you do not mean to)
- suffer from excessive sweating
- have a slow pulse
- suffer from hypotension (blood pressure that is much lower than usual)
- suffer from muscle spasmsIf you experience any of the side effects listed this may mean that you have been given an overdose and you should tell a doctor immediately.
Reporting of side effects
If you get any side effects, talk to your doctor, pharmacist or nurse: This includes any possible side effects not listed in this leaflet. By reporting side effects you can help provide more information on the safety of this medicine.
- How to store Neostigmine Methylsulfate Injection
Your injection will be stored at less than 25°C and protected from light. The nurse or doctor will check that the injection is not past its expiry date before giving you the injection.
- Contents of the pack and other information
What Neostigmine Methylsulfate Injection contains
The active ingredient is Neostigmine Methylsulfate. Each 1 ml of solution contains 2.5 mg neostigmine methylsulfate.
The other ingredients are Sodium Chloride, Sterile Water for Injections.
What Neostigmine Methylsulfate Injection looks like and contents of the pack
Neostigmine Methylsulfate Injection is a clear colourless solution in clear glass ampoules containing 2.5 mg neostigmine methylsulfate in 1 ml. 10 ampoules are supplied in each carton.
- Manufactured in India by:
TAJ PHARMACEUTICALS LTD.
Mumbai, India
Unit No. 214.Old Bake House,
Maharashtra chambers of Commerce Lane,
Fort, Mumbai – 400001
at:Gujarat, INDIA.
Customer Service and Product Inquiries:
1-800-TRY-FIRST (1-800-222-434 & 1-800-222-825)
Monday through Saturday 9:00 a.m. to 7:00 p.m. EST
E-mail: tajgroup@tajpharma.com
