Neostigmine Methylsulphate

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 The condition is usually self limiting, so the daily dose should be reduced gradually until the medicine can be withdrawn.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.