Neostigmine Side Effects

It is possible that some side effects of neostigmine may not have been reported. These can be reported to the FDA here. Always consult a healthcare professional for medical advice.

For the Consumer

Applies to neostigmine: oral tablet

As well as its needed effects, neostigmine may cause unwanted side effects that require medical attention.

If any of the following side effects occur while taking neostigmine, check with your doctor immediately:

More common
  • Twitches of the muscle visible under the skin
Incidence not known
  • Blurred or loss of vision
  • changes in patterns and rhythms of speech
  • chest pain or discomfort
  • confusion
  • cough
  • difficult or labored breathing
  • difficulty in moving
  • difficulty swallowing
  • disturbed color perception
  • dizziness, faintness, or lightheadedness when getting up from a lying or sitting position suddenly
  • double vision
  • fast, pounding, or irregular heartbeat or pulse
  • halos around lights
  • hives
  • irregular, fast or slow, or shallow breathing
  • itching
  • lightheadedness, dizziness, or fainting
  • loss of consciousness
  • muscle cramps and spasms
  • muscle pain or stiffness
  • night blindness
  • no blood pressure or pulse
  • noisy breathing
  • overbright appearance of lights
  • pain in joints
  • pale or blue lips, fingernails, or skin
  • puffiness or swelling of the eyelids or around the eyes, face, lips, or tongue
  • seizures
  • shortness of breath
  • skin rash
  • slow or irregular heartbeat
  • slurred speech
  • stopping of heart
  • sweating
  • tightness in chest
  • trouble in speaking
  • tunnel vision
  • unconsciousness
  • unusual tiredness or weakness
  • wheezing

If any of the following symptoms of overdose occur while taking neostigmine, get emergency help immediately:

Symptoms of Overdose
  • Constipation
  • decreased sexual ability
  • difficult urination
  • dry mouth
  • enlarged pupils
  • muscle weakness

Some neostigmine side effects may not need any medical attention. As your body gets used to the medicine these side effects may disappear. Your health care professional may be able to help you prevent or reduce these side effects, but do check with them if any of the following side effects continue, or if you are concerned about them:

More common
  • Increased watering of mouth
Incidence not known
  • Bloated
  • constricted, pinpoint, or small pupils (black part of eye)
  • diarrhea
  • drowsiness
  • excess air or gas in stomach or intestines
  • feeling of warmth
  • full feeling
  • headache
  • increase in mucous from lungs
  • increased need to urinate
  • increased sweating
  • nausea
  • passing gas
  • passing urine more often
  • redness of skin
  • redness of the face, neck, arms and occasionally, upper chest
  • skin rash
  • stomach cramps
  • vomiting

For Healthcare Professionals

Applies to neostigmine: compounding powder, injectable solution, intravenous solution, oral tablet

General

The most common side effects included salivation, fasciculation, bowel cramps and diarrhea.[Ref]

Cardiovascular

Common (1% to 10%): Bradycardia, hypotension, tachycardia
Frequency not reported: Nonspecific EKG changes, cardiac arrest, syncope
Postmarketing reports: Cardiac arrhythmias (A-V block, nodal rhythm)[Ref]

Dermatologic

Common (1% to 10%): Pruritus
Frequency not reported: Rash, urticaria[Ref]

Gastrointestinal

Common (1% to 10%): Dry mouth, nausea (including post-procedural), vomiting
Frequency not reported: Flatulence, increased peristalsis
Postmarketing reports: Bowel cramps, diarrhea[Ref]

Genitourinary

Frequency not reported: Urinary frequency[Ref]

Hypersensitivity

Frequency not reported: Allergic reactions and anaphylaxis[Ref]

Musculoskeletal

Frequency not reported: Muscle cramps and spasms, arthralgia
Postmarketing reports: Muscle weakness[Ref]

Nervous system

Common (1% to 10%): Dizziness, headache, postoperative shivering, prolonged neuromuscular blockade, insomnia
Postmarketing reports: Convulsions, drowsiness, dysarthria, fasciculation, loss of consciousness[Ref]

Ocular

Frequency not reported: Miosis, visual changes[Ref]

Other

Common (1% to 10%): Incision site complication, procedural complication and pain
Frequency not reported: Diaphoresis, flushing, weakness[Ref]

Renal

Postmarketing reports: Urinary frequency[Ref]

Respiratory

Common (1% to 10%): Pharyngolaryngeal pain, dyspnea, oxygen desaturation (less than 90%)
Frequency not reported: Increased oral, pharyngeal and bronchial secretions, dyspnea, respiratory depression, respiratory arrest, bronchospasm[Ref]

References

1. "Product Information. Bloxiverz (neostigmine)." Eclat Pharmaceuticals, Menomonee Falls,, WI.

2. "Product Information. Prostigman (neostigmine)." ICN Pharmaceuticals Inc, Cost Mesa, CA.

Disclaimer: Every effort has been made to ensure that the information provided is accurate, up-to-date and complete, but no guarantee is made to that effect. In addition, the drug information contained herein may be time sensitive and should not be utilized as a reference resource beyond the date hereof. This material does not endorse drugs, diagnose patients, or recommend therapy. This information is a reference resource designed as supplement to, and not a substitute for, the expertise, skill , knowledge, and judgement of healthcare practitioners in patient care. The absence of a warning for a given drug or combination thereof in no way should be construed to indicate safety, effectiveness, or appropriateness for any given patient. Drugs.com does not assume any responsibility for any aspect of healthcare administered with the aid of materials provided. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the substances you are taking, check with your doctor, nurse, or pharmacist.

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