Atropine antidote neostigmine8/9/2023 ![]() ![]() Adults Reversal of Neuromuscular Blockade IV Other experts have recommended IV doses of 0.025 to 0.07 mg/kg in neonates, 0.025–0.1 mg/kg in infants, and 0.025–0.08 mg/kg in children. (See Adults under Dosage and Administration.) Manufacturer states that pediatric patients may receive the same doses recommended for adults. ![]() Pediatric Patients Reversal of Neuromuscular Blockade IV DosageĪvailable as neostigmine methylsulfate dosage expressed in terms of the salt. † Parenteral Administrationįor solution and drug compatibility information, see Compatibility under Stability. Also has been administered by IM or sub-Q injection. If patient is bradycardic, give IV antimuscarinic before neostigmine.Īdminister by slow IV injection over a period of at least 1 minute. Recovery times may vary based on the patient's medical condition and duration of action of the specific neuromuscular blocking agent used.ĭispensing and Administration PrecautionsĪdminister only by trained clinicians experienced in the use of neuromuscular blocking agents and their reversal agents.Īlways have atropine and medications to treat anaphylaxis (e.g., epinephrine) readily available in case of hypersensitivity reaction.Īdminister IV atropine sulfate or glycopyrrolate immediately prior to or concurrently (in separate syringes) with neostigmine to counteract adverse muscarinic effects. Adequate recovery of neuromuscular function generally is defined as a train-of-four (TOF) ratio of 0.9 in addition to the patient's ability to maintain satisfactory ventilation and a patent airway. To exclude with certainty the possibility of residual paralysis, use an objective (quantitative) method of monitoring such as peripheral nerve stimulation in conjunction with other clinical assessments (e.g., observation of skeletal muscle tone, respiratory measurements). Continuous monitoring of neuromuscular function is recommended to ensure adequate reversal from the neuromuscular block. When used for reversal of neuromuscular blockade, patients must be well ventilated and have a patent airway prior to administration and until complete recovery of normal respiration. Neostigmine Dosage and Administration General Patient Monitoring Has been used in the management of severe constipation in patients with thoracic spinal cord injury †. Has been used as a prokinetic agent in patients with postoperative ileus following surgery † however, clinical usefulness may be limited by adverse muscarinic effects (e.g., bradycardia, increased bronchial secretions). May be effective as second-line therapy in patients who fail conservative therapy. Has been used for treatment of acute colonic pseudo-obstruction or Ogilvie syndrome †. If an anticholinesterase agent is required for symptomatic treatment of myasthenia gravis, pyridostigmine is the preferred drug. Has been used for symptomatic treatment of myasthenia gravis † to improve muscle strength however, oral preparation (e.g., Prostigmin ) previously used for this indication no longer commercially available in the US. Reversal of neuromuscular blockade should routinely be considered unless there is quantitative evidence indicating that no reversal is needed (TOF >0.9). Not effective and should not be used for reversal of depolarizing neuromuscular agents (e.g., succinylcholine).Īppropriate reversal of neuromuscular blocking agents is critical for preventing postoperative residual neuromuscular blockade. ![]() (See Neuromuscular Dysfunction under Cautions.) Not effective in antagonizing deep levels of neuromuscular blockade attempt reversal only after some degree of spontaneous recovery has occurred (e.g., when there is a detectable twitch response to the first TOF stimulus).ĭo not use in patients with complete neuromuscular recovery paradoxical neuromuscular effects (e.g., weakness of upper airway muscles, increased airway collapsibility) may occur. Reduces time to recovery of neuromuscular function (defined as a return of train-of-four twitch ratio to 0.9). Use in conjunction with an anticholinergic agent (atropine sulfate or glycopyrrolate) to counteract adverse muscarinic effects (e.g., bradycardia, bradyarrhythmias, increased secretions, bronchoconstriction). Reversal of the effects of nondepolarizing neuromuscular blocking agents (e.g., atracurium, cisatracurium, pancuronium, rocuronium, vecuronium). Uses for Neostigmine Reversal of Neuromuscular Blockade Written by ASHP.Īnticholinesterase agent. Drug class: Parasympathomimetic (Cholinergic) Agents ![]()
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