Pricing
Prices are indicative MRP and may vary by pharmacy. Trend compares against the last recorded price.
All price changes →Indications & Uses
Stigmin is used to control the symptoms of myasthenia gravis when oral therapy is impractical. It is also used to prevent and treat postoperative distention and urinary retention, but only after a mechanical obstruction has been excluded. The third use is after surgery, to reverse the effects of nondepolarizing neuromuscular blocking agents (for example Tubocurarine, metocurine, gallamine or pancuronium).
Pharmacology
Neostigmine Methylsulfate Injection is an anticholinesterase medicine. It is a sterile, nonpyrogenic solution of Neostigmine Methylsulfate in Water for Injections, and it is given by intramuscular (IM), intravenous (IV) or subcutaneous (SC) injection.
Neostigmine is a parasympathomimetic, and more precisely a reversible cholinesterase inhibitor. It blocks acetylcholinesterase, the enzyme that breaks down acetylcholine. With the enzyme blocked, more acetylcholine stays available. By interfering with the breakdown of acetylcholine, neostigmine indirectly stimulates both nicotinic and muscarinic receptors, which are involved in muscle contraction. Neostigmine does not cross the blood-brain barrier.
Dosage Reference
Reference Information Only
Dosages shown are general references from official sources. Always consult your doctor or pharmacist for personalized dosing.
Adults:
Antagonist to Nondepolarising Neuromuscular Blockade
For adults, give a single dose of Neostigmine Methylsulfate injection 2 to 3 mg with atropine sulphate 0.6-1.2 mg, by slow IV injection over 1 minute. The recommended ratio of atropine to Neostigmine Methylsulfate injection is 1:2 to 1:3. The maximum recommended dose in adults is 5 mg. For children, the suggested dose is 0.05 mg/kg/dose with atropine sulphate 0.02 mg/kg/dose, also by slow IV injection. The maximum recommended dose in children is 2.5 mg.
Myasthenia Gravis
Adults can have 1 mg to 2.5 mg given IM or SC at intervals through the day, at the times greater strength may be needed (for example in the morning and before meals). The total daily dose is 5 to 20 mg. A single dose acts for 2 to 4 hours. For neonates, the dose is 0.05-0.25 mg IM every 2-4 hours, half an hour before feeding. Treatment is not usually required beyond 8 weeks of age. The condition is usually self limiting, so the daily dose should be reduced gradually until the medicine can be withdrawn. When large doses of Neostigmine Methylsulfate injection are given to myasthenic patients, atropine sulphate may be required to counteract the muscarinic side effects.
Urinary Retention
For prophylaxis, give 0.25 mg SC or IM before the operation or immediately after it, and repeat every 4 to 6 hours for 2-3 days. For treatment, give 0.5 mg SC or IM and apply warmth to the lower abdomen. Once the patient has voided, continue with 0.5 mg SC or IM every 3 hours for at least 5 injections. If there is no urinary response within one hour of the first dose, the patient should be catheterised.
Side Effects
The side effects usually linked with an overdose of Stigmin (neostigmine methylsulphate) are grouped below by body system. Cardiovascular effects are cardiac arrhythmias (especially bradycardia), hypotension, cardiac arrest and syncope. In the central nervous system, there can be headache, dizziness, convulsions, loss of consciousness, coma, drowsiness, restlessness, ataxia, slurred speech, agitation and fear. Gastrointestinal effects include nausea, vomiting, diarrhoea, flatulence, abdominal cramps, increased peristalsis and involuntary defaecation. Genitourinary effects are involuntary urination or a desire to urinate. Musculoskeletal effects are muscle cramps, fasciculation, general weakness and paralysis. Respiratory effects are increased oral, pharyngeal and bronchial secretion, dyspnoea, bronchospasm, respiratory depression, respiratory failure, tight chest and wheezing. Allergic reactions can occur, including anaphylaxis. The skin may show rash and urticaria. Other effects are increased sweating and salivation, miosis, vision changes, nystagmus and lacrimation.
Cautions & Contraindications
Warnings & Precautions
Stigmin Methylsulfate should be used with caution in patients with epilepsy, bronchial asthma, bradycardia, recent coronary occlusion, vagotonia, hyperthyroidism, cardiac arrhythmias or peptic ulcer. If large doses of Stigmin Methylsulfate are given, it may be advisable to inject atropine sulfate before or at the same time. Use separate syringes for the Stigmin Methylsulfate and the atropine. An occasional patient may be hypersensitive, so atropine and antishock medication should always be readily available.
Contraindications
Neostigmine Methylsulfate injection should not be given to anyone who is known to be hypersensitive to the medicine. It is also contraindicated in patients with peritonitis, and in those with a mechanical obstruction of the intestinal or urinary tract.
Pregnancy & Breastfeeding
Neostigmine Methylsulfate is in Pregnancy Category C. There are no adequate or well-controlled studies of it in laboratory animals or in pregnant women. So it isn't known whether Neostigmine Methylsulfate can cause harm to the baby when given to a pregnant woman, or whether it can affect the ability to have children. It should be given to a pregnant woman only if it is clearly needed.
Nonteratogenic effects: Anticholinesterase drugs may cause uterine irritability and bring on premature labour when given IV to pregnant women near term.
Use in lactation: It isn't known whether Neostigmine Methylsulfate passes into human milk. Many drugs do pass into milk, and Neostigmine Methylsulfate could cause serious adverse reactions in nursing infants. So a decision should be made either to stop nursing or to stop the medicine, taking into account how important the medicine is to the mother.
⚠️ Talk to your doctor before taking any medicine during pregnancy or while breastfeeding.
Storage
Keep Neostigmine Methylsulphate at controlled room temperature and away from light. If any of the contents are left over after use, throw them away.
Drug Interactions
Common questions about G-Neostigmine 0.5 mg/ml
What is G-Neostigmine 0.5 mg/ml Injection?
G-Neostigmine 0.5 mg/ml Injection is a medicine that contains Neostigmine Methylsulphate. It is made by Gonoshasthaya Pharmaceuticals Ltd. It belongs to the Anti-cholinesterases group of medicines.
What is G-Neostigmine used for?
Stigmin is used to control the symptoms of myasthenia gravis when oral therapy is impractical. It is also used to prevent and treat postoperative distention and urinary retention, but only after a mechanical obstruction has been excluded.
What are the side effects of G-Neostigmine?
The side effects usually linked with an overdose of Stigmin (neostigmine methylsulphate) are grouped below by body system. Cardiovascular effects are cardiac arrhythmias (especially bradycardia), hypotension, cardiac arrest and syncope.
Can I take G-Neostigmine during pregnancy or while breastfeeding?
Neostigmine Methylsulfate is in Pregnancy Category C. There are no adequate or well-controlled studies of it in laboratory animals or in pregnant women. Talk to your doctor before taking any medicine during pregnancy or while breastfeeding.
How should I store G-Neostigmine?
Keep Neostigmine Methylsulphate at controlled room temperature and away from light. If any of the contents are left over after use, throw them away.
Can I take other medicines with G-Neostigmine?
Some medicines can interact with Neostigmine Methylsulphate, for example: Streptomycin, Kanamycin, Neomycin Sulphate. Tell your doctor or pharmacist about every medicine you take.
Do I need a prescription for G-Neostigmine?
G-Neostigmine is a prescription (Rx) medicine. Take it as your doctor advises.