Pronunciation:

nee-oh-STIG-meen

Brand Names:

• Prostigmin Bromide

Classifications:

Pharmacologic—

Cholinesterase Inhibitor

Uses of This Medicine:

Neostigmine is used to treat a muscle disease called myasthenia gravis. .

This medicine is available only with your doctor's prescription .

Before Using This Medicine:

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For this medicine, the following should be considered:

Allergies—

Tell your doctor if you have ever had any unusual or allergic reaction to this medicine or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.

Children—

Appropriate studies have not been performed on the relationship of age to the effects of neostigmine in the pediatric population. Safety and efficacy have not been established .

Older adults—

No information is available on the relationship of age to the effects of neostigmine in geriatric patients .

Breast-feeding—

There are no adequate studies in women for determining infant risk when using this medication during breastfeeding. Weigh the potential benefits against the potential risks before taking this medication while breastfeeding.

Other medicines—

Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

• Amifampridine
• Bupropion
• Donepezil
• Hydroxychloroquine

Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

• Succinylcholine

Other interactions—

Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. Discuss with your healthcare professional the use of your medicine with food, alcohol, or tobacco.

Other medical problems—

The presence of other medical problems may affect the use of this medicine. Make sure you tell your doctor if you have any other medical problems, especially:

• Intestine blockage (blocked gut or abdomen) or
• Kidney blockage (blocked urine flow) or
• Peritonitis (lining of the abdomen is inflamed)—Should not be used in patients with these conditions.

• Asthma or
• Bradycardia (slow heartbeat) or
• Heart attack, recent or
• Heart rhythm problems or
• Overactive thyroid or
• Seizures or
• Stomach ulcer—Use with caution. May make these conditions worse.

Proper Use of This Medicine:

It is important to keep a daily record of when you take each dose and how long it lasts. This will help your doctor decide if your dose needs to be adjusted .

Dosing—

The dose of this medicine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

• For oral dosage form (tablets):
  • For myasthenia gravis:
    • Adults—The usual dose is 15 to 375 milligrams (mg) each day, given in divided doses. Your doctor may adjust your dose if needed.
    • Children—Use and dose must be determined by your doctor .

Missed dose—

If you miss a dose of this medicine, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.

Storage—

Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing.

Keep out of the reach of children.

Do not keep outdated medicine or medicine no longer needed.

Ask your healthcare professional how you should dispose of any medicine you do not use.

Precautions While Using This Medicine:

It is very important that your doctor check your progress at regular visits to make sure that this medicine is working properly and to check for unwanted effects .

If your symptoms do not improve or if they become worse, check with your doctor .

Side Effects of This Medicine:

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if any of the following side effects occur:

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

Get emergency help immediately if any of the following symptoms of overdose occur:

Symptoms of Overdose

Constipation

decreased sexual ability

difficult urination

dry mouth

enlarged pupils

muscle weakness

Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions 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

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.