neostigmine (Rx)

Brand and Other Names:Prostigmin, Bloxiverz
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

injectable solution (methylsulfate salt; Bloxiverz)

  • 0.5mg/mL
  • 1mg/mL

tablet (bromide salt; Prostigmin)

  • 15mg

Myasthenia Gravis

Acute: 0.5-2.5 mg IV/IM/SC qDay  

Maintenance: 15-375 mg/day PO divided q6-8hr

Use injectable with 0.6-1.2 mg atropine IV to counteract muscarinic effects

Myasthenia Gravis Diagnosis

0.022 mg/kg IM x1  

Discontinue all anticholinesterase agents for >8 hr

Give atropine 0.011 mg/kg IV (if IM give 30 minutes before) with neostigmine 0.022 mg/kg IM

If cholinergic response, stop test and give 0.4-0.6 mg atropine IV

If inconclusive, retest another day with neostigmine 0.031 mg/kg IM preceded by 0.016 mg/kg atropine

Nondepolarizing Neuromuscular Blockade, Reversal

0.03-0.07 mg/kg IV will generally achieve a TOF twitch ratio of 90% within 10-20 minutes of administration

Not to exceed 0.07 mg/kg or a cumulative total of 5 mg, whichever dose is less Inject by slow IV over at least 1 minute

Dose selection should be based on the extent of spontaneous recovery that has occurred at the time of administration, the half-life of the NMBA being reversed, and whether there is a need to rapidly reverse the NMBA

Administer an IV anticholinergic (eg, atropine, glycopyrrolate) prior to, or concomitantly with neostigmine for NMB reversal; if bradycardia present, give anticholinergic before neostigmine

0.03 mg/kg

  • Use for reversal of NMBAs with shorter half-lives (eg, rocuronium), OR
  • When the first twitch response to the TOF stimulus is substantially >10% of baseline or when a second twitch is present

0.07 mg/kg

  • Use for NMBAs with longer half-lives (eg, vecuronium, pancuronium), OR
  • When the first twitch response is relatively weak (ie, not substantially >10% of baseline), OR
  • There is need for more rapid recovery

Post-Op Distention or Urinary Retention

Prevention: 0.25mg IM after surgery. Repeat q4-6hr for 2-3 days

Treatment: 0.5-1 mg IM and up to q3hr PRN (for 5 doses for retention)

Colonic Pseudo-obstruction (Orphan)

Orphan designation for treatment of acute colonic pseudo-obstruction

Orphan sponsor

  • Luitpold Pharmaceuticals, Inc.; One Luitpold Drive, P. O. Box 9001; Shirley, NY 11967

Administration

IV TOF monitoring for NMB reversal

  • Peripheral nerve stimulation devices capable of delivering a train-of-four (TOF) stimulus are essential to effectively and safely adjust IV dose
  • There must be a twitch response to the first stimulus in the TOF of at least 10% of its baseline level (ie, the response before NMBA administration, prior to neostigmine)

Dosage Forms & Strengths

injectable solution (methylsulfate salt; Bloxiverz)

  • 0.5mg/mL
  • 1mg/mL

tablet (bromide salt; Prostigmin)

  • 15mg

Myasthenia Gravis Diagnosis

Use with atropine

0.025-0.04 mg/kg IM x1  

Myasthenia Gravis Treatment

Use with atropine

0.01-0.04 mg/kg IV/IM/SC q2-3hr PRN  

2 mg/kg/day divided q4hr PO; no more than 375mg/day

Nondepolarizing Neuromuscular Blockade, Reversal

Adult guidelines should be followed when administered to pediatric patients, including neonates; pediatric patients require doses similar to those for adults

0.03-0.07 mg/kg IV will generally achieve a TOF twitch ratio of 90% within 10-20 minutes of administration

Not to exceed 0.07 mg/kg or a cumulative total of 5 mg, whichever dose is less Inject by slow IV over at least 1 minute

Dose selection should be based on the extent of spontaneous recovery that has occurred at the time of administration, the half-life of the NMBA being reversed, and whether there is a need to rapidly reverse the NMBA

Administer an IV anticholinergic (eg, atropine, glycopyrrolate) prior to, or concomitantly with neostigmine for NMB reversal; if bradycardia present, give anticholinergic before neostigmine

0.03 mg/kg

  • Use for reversal of NMBAs with shorter half-lives (eg, rocuronium), OR
  • When the first twitch response to the TOF stimulus is substantially >10% of baseline or when a second twitch is present

0.07 mg/kg

  • Use for NMBAs with longer half-lives (eg, vecuronium, pancuronium), OR
  • When the first twitch response is relatively weak (ie, not substantially >10% of baseline), OR
  • There is need for more rapid recovery

Administration

IV TOF monitoring for NMB reversal

  • Peripheral nerve stimulation devices capable of delivering a train-of-four (TOF) stimulus are essential to effectively and safely adjust IV dose
  • There must be a twitch response to the first stimulus in the TOF of at least 10% of its baseline level (ie, the response before NMBA administration, prior to neostigmine)
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Interactions

Interaction Checker

and neostigmine

No Results

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    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

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             activity indicator 

            Contraindicated (0)

              Serious - Use Alternative (2)

              • ponesimod

                ponesimod, neostigmine. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Consult cardiologist if considering treatment. Coadministration of ponesimod with drugs that decrease HR may have additive effects on decreasing HR and should generally not be initiated in these patients.

              • triamcinolone acetonide injectable suspension

                triamcinolone acetonide injectable suspension, neostigmine. unspecified interaction mechanism. Avoid or Use Alternate Drug. Concomitant use of anticholinesterase agents and corticosteroids may produce severe weakness in patients with myasthenia gravis. If possible, withdraw anticholinesterase agents at least 24 hours before initiating corticosteroid therapy.

              Monitor Closely (66)

              • aclidinium

                neostigmine increases and aclidinium decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • amifampridine

                amifampridine and neostigmine both increase cholinergic effects/transmission. Use Caution/Monitor.

              • amitriptyline

                neostigmine increases and amitriptyline decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.

              • amoxapine

                neostigmine increases and amoxapine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • anticholinergic/sedative combos

                neostigmine increases and anticholinergic/sedative combos decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • atracurium

                neostigmine increases and atracurium decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • atropine

                neostigmine increases and atropine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • atropine IV/IM

                neostigmine increases and atropine IV/IM decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor. .

              • belladonna alkaloids

                neostigmine increases and belladonna alkaloids decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • belladonna and opium

                neostigmine increases and belladonna and opium decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • bethanechol

                bethanechol and neostigmine both increase cholinergic effects/transmission. Use Caution/Monitor.

              • carbachol

                carbachol and neostigmine both increase cholinergic effects/transmission. Use Caution/Monitor.

              • cevimeline

                cevimeline and neostigmine both increase cholinergic effects/transmission. Use Caution/Monitor.

              • cisatracurium

                neostigmine increases and cisatracurium decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • clomipramine

                neostigmine increases and clomipramine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • cyclizine

                neostigmine increases and cyclizine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • cyclobenzaprine

                neostigmine increases and cyclobenzaprine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • darifenacin

                neostigmine increases and darifenacin decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • dicyclomine

                neostigmine increases and dicyclomine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • diphenhydramine

                neostigmine increases and diphenhydramine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • donepezil

                donepezil and neostigmine both increase cholinergic effects/transmission. Use Caution/Monitor.

              • dosulepin

                neostigmine increases and dosulepin decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • doxepin

                neostigmine increases and doxepin decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • echothiophate iodide

                echothiophate iodide and neostigmine both increase cholinergic effects/transmission. Use Caution/Monitor.

              • fesoterodine

                neostigmine increases and fesoterodine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • flavoxate

                neostigmine increases and flavoxate decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • galantamine

                galantamine and neostigmine both increase cholinergic effects/transmission. Use Caution/Monitor.

              • glycopyrrolate

                neostigmine increases and glycopyrrolate decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • glycopyrrolate inhaled

                neostigmine increases and glycopyrrolate inhaled decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • henbane

                neostigmine increases and henbane decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • homatropine

                neostigmine increases and homatropine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • huperzine A

                huperzine A and neostigmine both increase cholinergic effects/transmission. Use Caution/Monitor.

              • hyoscyamine

                neostigmine increases and hyoscyamine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • hyoscyamine spray

                neostigmine increases and hyoscyamine spray decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor. .

              • imipramine

                neostigmine increases and imipramine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • ipratropium

                neostigmine increases and ipratropium decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • lofepramine

                neostigmine increases and lofepramine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • maprotiline

                neostigmine increases and maprotiline decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • meclizine

                neostigmine increases and meclizine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • methscopolamine

                neostigmine increases and methscopolamine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • nortriptyline

                neostigmine increases and nortriptyline decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • onabotulinumtoxinA

                neostigmine increases and onabotulinumtoxinA decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • orphenadrine

                neostigmine increases and orphenadrine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • oxybutynin

                neostigmine increases and oxybutynin decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • oxybutynin topical

                neostigmine increases and oxybutynin topical decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • oxybutynin transdermal

                neostigmine increases and oxybutynin transdermal decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • pancuronium

                neostigmine increases and pancuronium decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • physostigmine

                neostigmine and physostigmine both increase cholinergic effects/transmission. Use Caution/Monitor.

              • pilocarpine

                neostigmine and pilocarpine both increase cholinergic effects/transmission. Use Caution/Monitor.

              • pilocarpine ophthalmic

                neostigmine and pilocarpine ophthalmic both increase cholinergic effects/transmission. Use Caution/Monitor.

              • pralidoxime

                neostigmine increases and pralidoxime decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • propantheline

                neostigmine increases and propantheline decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • protriptyline

                neostigmine increases and protriptyline decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • pyridostigmine

                neostigmine and pyridostigmine both increase cholinergic effects/transmission. Use Caution/Monitor.

              • rapacuronium

                neostigmine increases and rapacuronium decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • rivastigmine

                neostigmine and rivastigmine both increase cholinergic effects/transmission. Use Caution/Monitor.

              • rocuronium

                neostigmine increases and rocuronium decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • scopolamine

                neostigmine increases and scopolamine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • solifenacin

                neostigmine increases and solifenacin decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • succinylcholine

                neostigmine and succinylcholine both increase cholinergic effects/transmission. Use Caution/Monitor.

              • tiotropium

                neostigmine increases and tiotropium decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • tolterodine

                neostigmine increases and tolterodine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • trimipramine

                neostigmine increases and trimipramine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • trospium chloride

                neostigmine increases and trospium chloride decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • umeclidinium bromide

                neostigmine increases and umeclidinium bromide decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor. Monitor when umeclidinium bromide is coadministered with cholinergic agents.

              • vecuronium

                neostigmine increases and vecuronium decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              Minor (22)

              • acebutolol

                acebutolol, neostigmine. Either increases effects of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive bradycardia.

              • atenolol

                atenolol, neostigmine. Either increases effects of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive bradycardia.

              • betaxolol

                betaxolol, neostigmine. Either increases effects of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive bradycardia.

              • bisoprolol

                bisoprolol, neostigmine. Either increases effects of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive bradycardia.

              • carvedilol

                carvedilol, neostigmine. Either increases effects of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive bradycardia.

              • celiprolol

                celiprolol, neostigmine. Either increases effects of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive bradycardia.

              • desipramine

                neostigmine increases and desipramine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Minor/Significance Unknown.

              • donepezil

                donepezil increases effects of neostigmine by pharmacodynamic synergism. Minor/Significance Unknown.

              • esmolol

                esmolol, neostigmine. Either increases effects of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive bradycardia.

              • galantamine

                galantamine increases effects of neostigmine by pharmacodynamic synergism. Minor/Significance Unknown.

              • labetalol

                labetalol, neostigmine. Either increases effects of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive bradycardia.

              • metoprolol

                metoprolol, neostigmine. Either increases effects of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive bradycardia.

              • nadolol

                nadolol, neostigmine. Either increases effects of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive bradycardia.

              • nebivolol

                nebivolol, neostigmine. Either increases effects of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive bradycardia.

              • pantothenic acid

                pantothenic acid, neostigmine. Either increases effects of the other by pharmacodynamic synergism. Minor/Significance Unknown.

              • penbutolol

                penbutolol, neostigmine. Either increases effects of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive bradycardia.

              • pindolol

                pindolol, neostigmine. Either increases effects of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive bradycardia.

              • procainamide

                procainamide decreases effects of neostigmine by pharmacodynamic antagonism. Minor/Significance Unknown.

              • propranolol

                propranolol, neostigmine. Either increases effects of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive bradycardia.

              • sotalol

                sotalol, neostigmine. Either increases effects of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive bradycardia.

              • timolol

                timolol, neostigmine. Either increases effects of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive bradycardia.

              • trazodone

                neostigmine increases and trazodone decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Minor/Significance Unknown.

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              Adverse Effects

              Frequency Not Defined

              Allergic: Allergic reactions and anaphylaxis

              Neurologic: Dizziness, convulsions, loss of consciousness, drowsiness, headache, dysarthria, miosis and visual changes

              Cardiovascular: Cardiac arrhythmias (including bradycardia, tachycardia, A-V block and nodal rhythm) and nonspecific EKG changes have been reported, as well as cardiac arrest, syncope and hypotension (predominantly with parenteral dosage form)

              Respiratory: Increased oral, pharyngeal and bronchial secretions, and dyspnea; respiratory depression, respiratory arrest and bronchospasm have been reported following the use of the injectable form

              Dermatologic: Rash and urticaria

              Gastrointestinal: Nausea, emesis, flatulence, and increased peristalsis and salivation

              Genitourinary: Urinary frequency

              Musculoskeletal: Muscle cramps and spasms, arthralgia

              Miscellaneous: Diaphoresis, flushing and weakness

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              Warnings

              Contraindications

              Hypersensitivity, previous history of reaction to bromides

              Peritonitis or mechanical GI or urinary tract obstruction

              Cautions

              To lessen risk of bradycardia, administer glycopyrrolate or atropine sulfate prior to therapy

              Caution in epilepsy, bronchial asthma, bradycardia, recent coronary occlusion, vagotonia, hyperthyroidism, cardiac arrhythmias, peptic ulcer

              In patients with certain cardiovascular conditions such as coronary artery disease, cardiac arrhythmias or recent acute coronary syndrome, risk of blood pressure and heart rate complications may be increased; risk of these complications may also be increased in patients with myasthenia gravis; standard antagonism with anticholinergics (eg, atropine) is generally successful to mitigate risk of cardiovascular complications

              Neonates; because of self-limiting nature of myasthenia gravis, reduce daily dosage gradually released until drug can be withdrawn

              Avoid large doses in situations where there might be an increased absorption rate from the intestinal tract; caution when coadministered with anticholinergic drugs because of decreased GI motility

              Differentiate between myasthenic crisis and cholinergic crisis caused by overdosage of neostigmine; both conditions result in extreme muscle weakness but require radically different treatment

              Large doses administered when neuromuscular blockade is minimal can produce neuromuscular dysfunction; the dose should be reduced if recovery from neuromuscular blockade is nearly complete

              Anticholinesterase insensitivity can develop

              If excess cholinergic symptoms develop, discontinue therapy

              Atropine and epinephrine must be available to treat a hypersensitivity reaction

              Not recomended for use in patients with vagotonia

              May prolong the phase 1 block of depolarizing muscle relaxants

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              Pregnancy & Lactation

              Pregnancy

              There are no adequate or well-controlled studies in pregnant women; not known whether neostigmine can cause fetal harm or affect reproductive capacity; should administer only if clearly needed

              Anticholinesterase drugs, including neostigmine, may cause uterine irritability and induce premature labor when administered to pregnant women near term

              Animal data

              • No adverse effects were noted in rats or rabbits treated with human equivalent doses of neostigmine methylsulfate doses up to 8.1 and 13 mcg/kg/day, respectively, during organogenesis (0.1 to 0.2 times the maximum recommended human dose of 5 mg/60 kg person/day based on body surface area comparisons)

              Lactation

              The drug has not been studied in lactating women; not known whether neostigmine methylsulfate is present in human milk, or has effects on milk production or breastfed child; the developmental and health benefits of breastfeeding should be considered along with mother’s need for therapy and any potential adverse effects on breastfed child from drug or from underlying maternal condition

              Pregnancy Categories

              A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

              B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

              C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

              D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

              X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

              NA: Information not available.

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              Pharmacology

              Mechanism of Action

              Competitive inhibitor of cholinesterase resulting in decreased hydrolysis of acetylcholine by cholinesterase; by reducing the breakdown of acetylcholine, neostigmine increases acetylcholine in the synaptic cleft which competes for the same binding site as nondepolarizing neuromuscular blocking agents, and reverses the neuromuscular blockade

              Absorption

              Bioavailability: 1-2% (PO); general PO:IV equivalence ~15 mg neostigmine bromide PO is equivalent to 0.5 mg neostigmine methylsulfate parenteral

              Onset: 1-20 min (IV); 20-30 min (IM)

              Duration: 2.5-4 hr (IM); 1-2 hr (IV)

              Peak plasma time: 30 min (IM); 1-2 hr (PO)

              Distribution

              Protein bound: 15-25% to albumin (PO)

              Metabolism

              Liver microsomal enzymes and hydrolysis by cholinesterase enzymes

              Elimination

              Half-Life: 47-60 min (IV); 51-90 min (IM); 42-60 min (PO)

              Excretion: 50% urine

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              Administration

              IV Incompatibilities: none specified

              IV Administration: slow IV injection

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              Images

              BRAND FORM. UNIT PRICE PILL IMAGE
              neostigmine methylsulfate intravenous
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              0.5 mg/mL vial
              neostigmine methylsulfate intravenous
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              1 mg/mL vial
              neostigmine methylsulfate intravenous
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              1 mg/mL vial
              neostigmine methylsulfate intravenous
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              0.5 mg/mL vial
              neostigmine methylsulfate intravenous
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              1 mg/mL vial
              neostigmine methylsulfate intravenous
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              0.5 mg/mL vial
              neostigmine methylsulfate intravenous
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              1 mg/mL vial
              neostigmine methylsulfate intravenous
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              0.5 mg/mL vial
              neostigmine methylsulfate intravenous
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              1 mg/mL vial
              neostigmine methylsulfate intravenous
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              1 mg/mL vial
              neostigmine methylsulfate intravenous
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              0.5 mg/mL vial
              neostigmine methylsulfate intravenous
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              0.5 mg/mL vial
              neostigmine methylsulfate intravenous
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              1 mg/mL vial
              neostigmine methylsulfate intravenous
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              1 mg/mL vial
              neostigmine methylsulfate intravenous
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              0.5 mg/mL vial
              neostigmine methylsulfate intravenous
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              0.5 mg/mL vial
              neostigmine methylsulfate intravenous
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              0.5 mg/mL vial
              neostigmine methylsulfate intravenous
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              0.5 mg/mL vial
              neostigmine methylsulfate intravenous
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              1 mg/mL vial
              neostigmine methylsulfate intravenous
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              3 mg/3 mL (1 mg/mL) solution
              neostigmine methylsulfate intravenous
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              0.5 mg/mL vial
              Bloxiverz intravenous
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              1 mg/mL vial
              Bloxiverz intravenous
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              1 mg/mL vial
              Bloxiverz intravenous
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              0.5 mg/mL vial
              Bloxiverz intravenous
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              0.5 mg/mL vial

              Copyright © 2010 First DataBank, Inc.

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              Patient Handout

              Patient Education
              neostigmine methylsulfate intravenous

              NO MONOGRAPH AVAILABLE AT THIS TIME

              USES: Consult your pharmacist.

              HOW TO USE: Consult your pharmacist.

              SIDE EFFECTS: Consult your pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

              PRECAUTIONS: Consult your pharmacist.

              DRUG INTERACTIONS: Consult your pharmacist.Keep a list of all your medications with you, and share the list with your doctor and pharmacist.

              OVERDOSE: If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center.

              NOTES: No monograph available at this time.

              MISSED DOSE: Consult your pharmacist.

              STORAGE: Consult your pharmacist.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company for more details about how to safely discard your product.

              Information last revised July 2016. Copyright(c) 2021 First Databank, Inc.

              IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.

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              Formulary

              FormularyPatient Discounts

              Adding plans allows you to compare formulary status to other drugs in the same class.

              To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.

              Adding plans allows you to:

              • View the formulary and any restrictions for each plan.
              • Manage and view all your plans together – even plans in different states.
              • Compare formulary status to other drugs in the same class.
              • Access your plan list on any device – mobile or desktop.

              The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

              Tier Description
              1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
              2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
              3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
              4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
              5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
              6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
              NC NOT COVERED – Drugs that are not covered by the plan.
              Code Definition
              PA Prior Authorization
              Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
              QL Quantity Limits
              Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
              ST Step Therapy
              Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
              OR Other Restrictions
              Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
              Additional Offers
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              Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.