Paralytic ileus, Postoperative urinary retention
Adult: As neostigmine methylsulfate: 0.5-2.5 mg via IM or SC inj. Dosing recommendations may vary among countries and individual products (refer to specific product guidelines).
Child: As neostigmine methylsulfate: 0.125-1 mg via IM or SC inj. Dosing recommendations may vary among countries and individual products and between countries (refer to specific product guidelines).
Child: As neostigmine methylsulfate: 0.125-1 mg via IM or SC inj. Dosing recommendations may vary among countries and individual products and between countries (refer to specific product guidelines).
Intramuscular, Subcutaneous
Myasthenia gravis
Adult: Dosage and frequency of dosing is individualised according to the patient's needs and response. As neostigmine methylsulfate: 1-2.5 mg via IM or SC inj. Usual total daily dose: 5-20 mg. Doses are given at adequate intervals and should be adjusted based on the patient's response.
Child: As neostigmine methylsulfate: >1 month to 11 years 0.2-0.5 mg via IM or SC inj; 12-17 years Same as adult dose. Doses are given at adequate intervals and should be adjusted based on the patient's response.
Neonate: As neostigmine methylsulfate: 0.15 mg/kg 6-8 hourly via IM or SC inj, given 30 minutes before feeds. If necessary, doses may be increased to 0.3 mg/kg 4 hourly. Due to the self-limiting nature of the disease, reduce doses until the drug can be withdrawn. Dosage and treatment recommendations may vary and may be off-label in certain countries (refer to specific product or country guidelines).
Child: As neostigmine methylsulfate: >1 month to 11 years 0.2-0.5 mg via IM or SC inj; 12-17 years Same as adult dose. Doses are given at adequate intervals and should be adjusted based on the patient's response.
Neonate: As neostigmine methylsulfate: 0.15 mg/kg 6-8 hourly via IM or SC inj, given 30 minutes before feeds. If necessary, doses may be increased to 0.3 mg/kg 4 hourly. Due to the self-limiting nature of the disease, reduce doses until the drug can be withdrawn. Dosage and treatment recommendations may vary and may be off-label in certain countries (refer to specific product or country guidelines).
Intravenous
Reversal of neuromuscular blockade
Adult: As neostigmine methylsulfate: 0.03-0.07 mg/kg via slow IV inj over 60 seconds. May repeat dose, if needed. Max dose: 0.07 mg/kg or up to a total of 5 mg (whichever is less). Dosage is individualised based on the patient's response and the degree of neuromuscular block. Anticholinergic agents (e.g. atropine or glycopyrronium bromide) should be given concomitantly with each dose; if the patient is experiencing bradycardia, the pulse rate should be increased by administering the anticholinergic agent before the neostigmine dose. Dosing recommendations may vary among individual products and between countries. (refer to specific product guidelines).
Child: As neostigmine methylsulfate: 0.05 mg/kg via slow IV inj over 60 seconds, may give a further dose of 0.025 mg if needed. Max dose: 2.5 mg. Dosage is individualised based on the patient's response and the degree of neuromuscular block. Dosing recommendations may vary among individual products and between countries (refer to specific product guidelines).
Neonate: As neostigmine methylsulfate: 0.03-0.07 mg/kg via slow IV inj over several minutes. Max dose: 0.07 mg/kg or up to a total of 5 mg (whichever is less). Dosage is individualised based on the patient's response and the degree of neuromuscular block. Anticholinergic agents (e.g. atropine or glycopyrronium bromide) should be given concomitantly with each dose; if the patient is experiencing bradycardia, the pulse rate should be increased by administering the anticholinergic agent before the neostigmine dose. Dosing recommendations may vary among individual products and between countries. (refer to specific product guidelines).
Child: As neostigmine methylsulfate: 0.05 mg/kg via slow IV inj over 60 seconds, may give a further dose of 0.025 mg if needed. Max dose: 2.5 mg. Dosage is individualised based on the patient's response and the degree of neuromuscular block. Dosing recommendations may vary among individual products and between countries (refer to specific product guidelines).
Neonate: As neostigmine methylsulfate: 0.03-0.07 mg/kg via slow IV inj over several minutes. Max dose: 0.07 mg/kg or up to a total of 5 mg (whichever is less). Dosage is individualised based on the patient's response and the degree of neuromuscular block. Anticholinergic agents (e.g. atropine or glycopyrronium bromide) should be given concomitantly with each dose; if the patient is experiencing bradycardia, the pulse rate should be increased by administering the anticholinergic agent before the neostigmine dose. Dosing recommendations may vary among individual products and between countries. (refer to specific product guidelines).
Oral
Paralytic ileus, Postoperative urinary retention
Adult: As neostigmine bromide: 15-30 mg. Dosing frequency may vary based on the patient's response. Dosage and treatment recommendations may vary among countries and individual products (refer to specific product or country guidelines).
Child: As neostigmine bromide: 2.5-15 mg. Dosing frequency may vary based on the patient's response. Dosage and treatment recommendations may vary among countries and individual products (refer to specific product or country guidelines).
Child: As neostigmine bromide: 2.5-15 mg. Dosing frequency may vary based on the patient's response. Dosage and treatment recommendations may vary among countries and individual products (refer to specific product or country guidelines).
Oral
Myasthenia gravis
Adult: Dosage and frequency of dosing is individualised according to the patient's needs and response. As neostigmine bromide: Initially, 15-30 mg. Usual total daily dose: 75-300 mg. Doses are given at adequate intervals throughout the day when maximum strength is needed (e.g. on rising and before mealtimes); may administer larger portions of the total daily dose at times of greater fatigue.
Child: As neostigmine bromide: <6 years Initially, 7.5 mg; ≥6-12 years Initially, 15 mg. Doses are adjusted based on the patient’s response up to a total dailys dose of 15-90 mg.
Child: As neostigmine bromide: <6 years Initially, 7.5 mg; ≥6-12 years Initially, 15 mg. Doses are adjusted based on the patient’s response up to a total dailys dose of 15-90 mg.