Neostigmine (Injection)

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

Neostigmine (Injection) is also used to prevent or treat certain kidney or intestinal problems. This medicine is also given after surgery to help reverse the effects of certain types of medicines that have been used to relax the muscles.

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

Your doctor will provide you with a limited number of doses of this medicine until your condition gets better, after which you will be transitioned to an oral medicine that functions similarly. If you have any questions about this, please speak with your doctor.

In deciding to use a medicine, you need to consider the risks of taking it against the benefits it provides. This is a decision you will make with your doctor. For this medicine, think about the following:

Allergies

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

Pediatric

There have not been appropriate studies on how neostigmine injection affects children. Safety and effectiveness have not been established.

Studies done so far have not shown any specific problems in children that would limit the use of Bloxiverz™. However, infants and small children may be more sensitive to the effects of this medicine.

Geriatric

There is no information available on how neostigmine injection affects older patients.

Studies performed so far have not indicated any specific problems in older patients that would limit the use of Bloxiverz™. However, older patients are more likely to have age-related kidney issues, which may require caution for those receiving Bloxiverz™.

Breast Feeding

There are no adequate studies in women to determine the risk to infants when using this medicine while breastfeeding. Weigh the potential benefits against the potential risks before taking this medicine while breastfeeding.

Interactions with Medicines

Some medicines should not be used together at all, while others may be used together even if an interaction might occur. In these situations, your doctor may want to adjust the dose, or other precautions may be necessary. When receiving this medicine, it is especially important for your healthcare professional to know if you are taking any of the medicines listed below. The following interactions are significant but may not include all possible interactions.

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

• Amifampridine
• Bupropion
• Donepezil

Using this medicine with any of the following medicines may increase the 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 adjust the dose or how often you take one or both of the medicines.

• Succinylcholine

Interactions with Food/Tobacco/Alcohol

Some medicines should not be taken around the time of eating food or certain types of food due to possible interactions. Using alcohol or tobacco with certain medicines may also cause interactions. Discuss with your healthcare professional about using your medicine with food, alcohol, or tobacco.

Other Medical Problems

Having other medical problems may affect the use of this medicine. Make sure to inform your doctor if you have any other medical issues, especially:

• Asthma or
• Bradycardia (slow heartbeat) or
• Coronary artery disease (heart disease) or
• Recent heart attack or
• Heart rhythm problems or
• Hypotension (low blood pressure) or
• Overactive thyroid or
• Seizures or
• Stomach ulcer—Use with caution. This may worsen these conditions.

• Intestinal (bowel) blockage or
• Peritonitis (swelling of the lining of the abdomen or stomach) or
• Urinary tract blockage—Should not be used in patients with these conditions.

• Kidney disease—Use with caution. The effects may be stronger due to slower removal of the medicine from the body.

Along with its necessary effects, this medicine may cause some unwanted effects. Not all of these side effects may happen, but if they do, they might need medical attention.

Check with your doctor or nurse right away if any of the following side effects happen:

More common

• Blurred or loss of vision
• Chest pain, discomfort, or tightness
• Confusion
• Difficulty or labored breathing
• Dizziness, faintness, or lightheadedness when standing up quickly from a lying or sitting position
• Fast, slow, pounding, or irregular heartbeat or pulse
• Lightheadedness, dizziness, or fainting
• Sweating
• Visible muscle twitches under the skin
• Unusual tiredness or weakness

Incidence not known

• Changes in speech patterns and rhythms
• Cough
• Difficulty moving
• Difficulty swallowing
• Disturbed color perception
• Double vision
• Halos around lights
• Hives
• Irregular, fast or slow, or shallow breathing
• Itching
• Loss of consciousness
• Muscle cramps and spasms
• Muscle pain or stiffness
• Night blindness
• No blood pressure or pulse
• Noisy breathing
• Overbright appearance of lights
• Joint pain
• Pale or blue lips, fingernails, or skin
• Puffiness or swelling of the eyelids or around the eyes, face, lips, or tongue
• Seizures
• Skin rash
• Slurred speech
• Stopping of the heart
• Trouble speaking
• Tunnel vision
• Unconsciousness

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

Symptoms of Overdose

• Constipation
• Decreased sexual ability
• Difficulty urinating
• Dry mouth
• Enlarged pupils
• Muscle weakness

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

More common

• Bleeding, blistering, burning, coldness, discoloration of skin, feeling of pressure, hives, infection, inflammation, itching, lumps, numbness, pain, rash, redness, scarring, soreness, stinging, swelling, tenderness, tingling, ulceration, or warmth at the site
• Drowsiness
• Headache
• Increased watering of the mouth
• Nausea
• Sleeplessness
• Sore throat
• Trouble sleeping
• Unable to sleep
• Vomiting

Incidence not known

• Bloated
• Constricted, pinpoint, or small pupils (black part of the eye)
• Diarrhea
• Dry mouth
• Excess air or gas in the stomach or intestines
• Feeling of warmth
• Full feeling
• Increased mucus from the lungs
• Increased need to urinate
• Increased sweating
• Passing gas
• Urinating more often
• Redness of the face, neck, arms, and occasionally, upper chest
• Redness of the skin
• Skin rash
• Stomach cramps

Other side effects not listed may also happen 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.

Available Dosage Forms:

• Solution

Therapeutic Class: Central Nervous System Agent

Pharmacologic Class: Cholinesterase Inhibitor

A nurse or other trained health professional will give you this medicine. This medicine is given through a needle placed into one of your veins, under your skin, or into your muscle.