Neostigmine (Oral)

Neostigmine is used to treat a muscle disease known as myasthenia gravis.

This medicine is only available with a prescription from your doctor.

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

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

In deciding to use a medicine, you and your doctor need to consider the risks of taking the medicine against the benefits it may provide. Here are some important points to think about for this medicine:

Allergies

Inform your doctor if you have ever had any unusual or allergic reactions to this medicine or any other medicines. Also, let your healthcare professional know if you have any other allergies, like to foods, dyes, preservatives, or animals. For non-prescription products, carefully read the label or package ingredients.

Pediatric

There have not been enough studies to determine how neostigmine affects children. Its safety and effectiveness have not been established.

Geriatric

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

Breast Feeding

There are no sufficient studies in women to determine the risk to infants when using this medicine while breastfeeding. Consider the potential benefits and risks before taking this medicine during breastfeeding.

Interactions with Medicines

Some medicines should not be used together at all, while others can be used together even if there might be an interaction. In those cases, your doctor may adjust the dose or take other precautions. It's especially important for your healthcare professional to know if you are taking any of the medicines listed below while you are on this medicine. The following interactions are based on their potential significance and are not all-inclusive.

Using this medicine with any of the following medicines is generally not recommended, but it may be necessary in some situations. If both medicines are prescribed together, your doctor may change the dose or frequency of one or both medicines.

• Amifampridine
• Bupropion
• Donepezil

Using this medicine with any of the following medicines may increase the risk of certain side effects, but it may be the best treatment option for you. If both medicines are prescribed together, your doctor may adjust the dose or frequency of one or both medicines.

• Succinylcholine

Interactions with Food/Tobacco/Alcohol

Certain medicines should not be taken at or around mealtimes or with specific types of food due to possible interactions. Drinking alcohol or using tobacco with certain medicines may also lead to interactions. Discuss with your healthcare professional about using your medicine with food, alcohol, or tobacco.

Other Medical Problems

Other medical issues may influence the use of this medicine. Be sure to tell your doctor if you have any other medical conditions, especially:

• Intestine blockage (blocked gut or abdomen) or
• Kidney blockage (blocked urine flow) or
• Peritonitis (inflammation of the abdominal lining)—This medicine should not be used if you have these conditions.

• Asthma or
• Bradycardia (slow heartbeat) or
• Recent heart attack or
• Heart rhythm problems or
• Overactive thyroid or
• Seizures or
• Stomach ulcer—Use with caution. This medicine may worsen these conditions.

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

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

More common

• Muscle twitches that you can see under the skin

Incidence not known

• Blurred or lost vision
• Changes in how you speak
• Chest pain or discomfort
• Confusion
• Cough
• Trouble breathing or breathing hard
• Difficulty moving
• Difficulty swallowing
• Changes in color vision
• Dizziness, faintness, or feeling lightheaded when standing up suddenly
• Double vision
• Fast, pounding, or irregular heartbeat or pulse
• Halos around lights
• Hives
• Irregular, fast, 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
• Lights appearing too bright
• Joint pain
• Pale or blue lips, fingernails, or skin
• 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 speaking
• Tunnel vision
• Unconsciousness
• Unusual tiredness or weakness
• Wheezing

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

Symptoms of Overdose

• Constipation
• Decreased sexual ability
• Trouble 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. Your health care professional may also be able to tell you about ways to prevent or lessen some of these side effects. Check with your health care professional if any of the following side effects continue, are bothersome, or if you have any questions about them:

More common

• Increased saliva production

Incidence not known

• Feeling bloated
• Constricted, pinpoint, or small pupils (the black part of the eye)
• Diarrhea
• Drowsiness
• Excess gas in the stomach or intestines
• Feeling warm
• Feeling full
• Headache
• Increased mucus from lungs
• Increased need to urinate
• Increased sweating
• Nausea
• Passing gas
• Urinating more often
• Skin redness
• Redness of the face, neck, arms, and sometimes, the 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.

In the U.S.

• Prostigmin Bromide

Pharmacologic Class: Cholinesterase Inhibitor

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.