====== Prostigmine (Neostigmine) ======

=====Effects=====

**Anticholinesterase drug**
  * Reduces breakdown of Acetylcholine in the neuromuscular junction by inhibiting acetylcholinesterase
  * Reversibly binds to and inactivates acetylcholinesterase
  * Has less effect on the eye, heart and brain than physostigmine but has more effect on GI tract and bladder
  * [[http://www.pharmacorama.com/en/Sections/Acetylcholine_2_2.php#7|Acetylcholine Effects]]

=====Dosing=====

**To diagnose Myasthenia Gravis**
  * 1mg for 70kg Adult (or 0.02 mg/kg) IM, Give with 0.4 mg Atropine IM
**To treat Myasthenia Gravis**
  * Start with 15 mg PO Q8h, Max 375 mg/day
  * 15 mg PO = 0.5 mg SC/IM/IV
====Renal dosing====
  * Creatinine Clearance 10-50 decrease dose by 50%
  * Creatinine Clearance <10 decrease dose by 75%
=====Excretion=====
  * Urine (50% unchanged)
  * Recommended Creatinine level at baseline
=====Side Effects=====

**Common Reactions**
  * hypersalivation
  * fasciculation
  * abdominal bloating/cramps
  * loose stools/diarrhea
  * flatulence
  * dyspepsia
  * headache
  * dizziness
  * diaphoresis
  * lacrimation increase
  * rhinorrhea
  * pulmonary secretions increase
  * dyspnea
  * nausea/vomiting
  * urinary frequency/urgency
  * muscle weakness/cramps
  * miosis
  * visual changes
  * rash
  * drowsiness
**Serious Reactions**
  * Cholinergic crisis:
    * overstimulation at the neuromuscular junction leading to 
      * flaccid paralysis
      * respiratory failure
      * increased sweating
      * salivation
      * bronchial secretions
      * mitosis
    * treated with Atropine
  * bradycardia
  * AV block
  * arrhythmias
  * hypotension
  * severe syncope
  * cardiac arrest
  * bronchospasm
  * respiratory depression
  * respiratory arrest
  * respiratory paralysis
  * paralysis
  * anaphylaxis
  * hypersensitivity reaction
  * seizures

{{tag>drugs}}