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Neostigmine Dosage

Applies to the following strengths: 0.5 mg/mL; 1 mg/mL; 15 mg; 0.25 mg/mL

Usual Adult Dose for Reversal of Neuromuscular Blockade

Initial dose: 0.03 mg/kg to 0.07 mg/kg injected intravenously over a period of at least 1 minute
Maximum dose: 0.07 mg/kg or up to a total of 5 mg, whichever is less

Comments:
-Administer an anticholinergic agent intravenously prior to or concomitantly with neostigmine using a separate syringe. In the presence of bradycardia, administer the anticholinergic prior to neostigmine
-Administered by trained healthcare providers familiar with neuromuscular blocking and reversal agents
-Use a peripheral nerve stimulator to determine initiation time and need for additional doses

Usual Adult Dose for Myasthenia Gravis

Oral:
15 to 375 mg orally daily
Average dose: 150 mg (10 tablets) orally over a 24 hour period

Comments:
-Therapy is required day and night with the larger portion of the total daily dose given at times when the patient is more prone to fatigue
-Dosage schedule should be individualized for each patient

Parenteral:
1 mL of 1:2000 solution (0.5 mg) subcutaneously or intramuscularly

Usual Adult Dose for Urinary Retention

Prevention of Postoperative Distention:
Initial dose: 0.25 mg subcutaneously or intramuscularly as soon as possible after operation
Duration of therapy: Repeat every 4 to 6 hours for 2 to 3 days.
Treatment of Postoperative Distention: 1 mL of 1:2000 solution (0.5 mg) subcutaneously or intramuscularly

Prevention of Urinary Retention:
Initial dose: 0.25 mg subcutaneously or intramuscularly as soon as possible after operation
Duration of therapy: Repeat every 4 to 6 hours for 2 to 3 days
Treatment of Urinary Retention:
Initial: 1 mL of 1:2000 solution (0.5 mg) subcutaneously or intramuscularly
Duration of therapy: After patient has voided continue 0.5 mg subcutaneously or intramuscularly every 3 hours for at least 5 injections.

Comments:
-If urination does not occur in an hour consider catherization

Usual Pediatric Dose for Reversal of Neuromuscular Blockade

Initial dose: 0.03 mg/kg to 0.07 mg/kg injected intravenously over a period of at least 1 minute
Maximum dose: 0.07 mg/kg or up to a total of 5 mg, whichever is less

Comments:
-Administer an anticholinergic agent intravenously prior to or concomitantly with neostigmine using a separate syringe. In the presence of bradycardia, administer the anticholinergic prior to neostigmine
-Administered by trained healthcare providers familiar with neuromuscular blocking and reversal agents
-Use a peripheral nerve stimulator to determine initiation time and need for additional doses

Renal Dose Adjustments

No adjustment recommended
Use with caution

Liver Dose Adjustments

No adjustment recommended
Use with caution

Dose Adjustments

For Bloxiverz (neostigmine methylsulfate injection):
The 0.03 mg/kg dose recommended for:
-Reversal of neuromuscular blocking agents (NMBAs) with shorter half-lives
-When first twitch response to the train-of-four (TOF) stimulus is substantially greater than 10% of baseline or when a second twitch response is present

The 0.07 mg/kg dose recommended for:
-NMBAs with longer half-lives
-When the first twitch response is relatively weak
-There is need for a rapid recovery

Precautions

Consult WARNINGS section for dosing related precautions

Dialysis

Data not available

Other Comments

Storage requirements: Protect neostigmine methylsulfate injection from light and store in the original carton until ready to use

General: The vial stopper of Bloxiverz (neostigmine methylsulfate injection) in not made with natural rubber latex

Monitoring: Use peripheral nerve stimulator and twitch responses to determine time of treatment initiation and need for additional doses

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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