WHO Model Prescribing Information: Drugs Used in Anaesthesia
(1989; 60 pages) [French] Ver el documento en el formato PDF
Índice de contenido
Ver el documentoPreface
Ver el documentoIntroduction
Abrir esta carpeta y ver su contenidoPremedication
Abrir esta carpeta y ver su contenidoGeneral anaesthetics and oxygen
Abrir esta carpeta y ver su contenidoLocal anaesthetics
Abrir esta carpeta y ver su contenidoNon-opioid analgesics
Abrir esta carpeta y ver su contenidoOpioid analgesics and antagonists
Cerrar esta carpetaMuscle relaxants and cholinesterase inhibitors
Ver el documentoGallamine
Ver el documentoSuxamethonium
Ver el documentoNeostigmine
Abrir esta carpeta y ver su contenidoBlood substitutes
Abrir esta carpeta y ver su contenidoSolutions for correcting water and electrolyte imbalance
Abrir esta carpeta y ver su contenidoAntacid for use in obstetric practice
Ver el documentoAnaesthesia at the District Hospital
Ver el documentoSelected WHO publications of related interest
Ver el documentoBack cover


Group: cholinesterase inhibitor
Injection: 0.5, 2.5 mg (metilsulfate)/ml in 1-ml ampoule

General information

Neostigmine is a cholinesterase inhibitor that raises the concentration of acetylcholine at the myoneural junction and other cholinergic nerve endings. Administered parenterally, the effect of a single dose persists for 2-4 hours. It is destroyed by plasma esterases and excreted in the urine.

Clinical information


• To counteract the effect of non-depolarizing muscle relaxants administered during surgery.

• Treatment of postoperative non-obstructive urinary retention.


Reversal of muscle relaxation

Adults: 2.5 mg by i.v. injection. Supplements of 0.5 mg may be administered as necessary up to a maximum of 5 mg. Atropine sulfate (600-1200 micrograms i.v.) administered immediately beforehand prevents autonomic excitation.

Children: 40 micrograms/kg i.v. after atropine sulfate (20 micrograms/kg i.v.) administered as above.

Titration of the required dose using a peripheral-nerve stimulator is advisable in small children and severely ill patients.

The initial dose should be reduced in patients with bronchial asthma, postoperative atelectasis, bradycardia, atrioventricular block and other cardiac dysrhythmias, epilepsy and parkinsonism.

Postoperative non-obstructive urinary retention

Adults: 500 micrograms i.m. or subcutaneously initially, repeated every 3 hours for at least 15 hours once the patient has voided the bladder. If urine is not passed within 1 hour of the initial dose the patient’s bladder should be catheterized. Cystoscopy is indicated if retention persists.


• Hypersensitivity to neostigmine.
• Peritonitis.
• Mechanical obstruction of the intestinal or urinary tracts.


Equipment for resuscitation and mechanically assisted respiration should be immediately available.

Neostigmine should be given only after halothane or ether administration has been discontinued.

Adequate ventilation must be maintained since respiratory acidosis predisposes the patient to cardiac dysrhythmias.

Use in pregnancy

Neostigmine should be administered only when the need outweighs any possible risk to the fetus. Premature labour has been induced following intravenous administration near term.

Adverse effects

Neostigmine may produce signs of excessive cholinergic activity, including nausea and vomiting, increased salivation, diarrhoea, abdominal cramps, cardiac dysrhythmias, syncope and hypotension.

Rash, urticaria and anaphylaxis have been reported.

Drug interactions

Neostigmine potentiates the effect of depolarizing muscle relaxants. It should therefore not be used in conjunction with suxamethonium.


Sudden death may occur as a result of cardiac arrest. More frequently a “cholinergic crisis” is induced, characterized by nausea, vomiting, diarrhoea, excess salivation and rapidly progressive paralysis. Ventilation must be mechanically assisted until spontaneous breathing returns. Atropine (1 mg i.v.) serves to block the autonomic effects.


Neostigmine should be stored in ampoules protected from light, and should not be allowed to freeze.

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