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Neostigmine Methylsulfate (neostigmine methylsulfate (neostigmine methylsulfate injection) injection) Injection, USP should be used with caution in patients with epilepsy, bronchial asthma, bradycardia, recent coronary occlusion, vagotonia, hyperthyroidism, cardiac arrhythmias or peptic ulcer.When large doses of Neostigmine are administered, the prior or simultaneous injection of Atropine Sulfate may be advisable.Separate syringes should be used for the Neostigmine and Atropine.Because of the possibility of hypersensitivity in an occasional patient, Atropine and anti-shock medication should always be readily available.

General

It is important to differentiate between myasthenic crisis and cholinergic crisis caused by overdosage of Neostigmine Methylsulfate (neostigmine methylsulfate (neostigmine methylsulfate injection) injection) .Both conditions result in extreme muscle weakness but require radically different treatment (see OVERDOSE).

Carcinogenesis, Mutagenesis and Impairment of Fertility

There have been no studies with Neostigmine Methylsulfate (neostigmine methylsulfate (neostigmine methylsulfate injection) injection) which would permit an evaluation of its carcinogenic or mutagenic potential. Studies on the effect of Neostigmine Methylsulfate (neostigmine methylsulfate (neostigmine methylsulfate injection) injection) on fertility and reproduction have not been performed.

Pregnancy

Teratogenic Effects

Pregnancy Category C.There are no adequate or well-controlled studies of Neostigmine Methylsulfate (neostigmine methylsulfate (neostigmine methylsulfate injection) injection) in either laboratory animals or in pregnant women.It is not known whether Neostigmine can cause fetal harm when administered to a pregnant woman or can affect reproductive capacity. Neostigmine Methylsulfate (neostigmine methylsulfate (neostigmine methylsulfate injection) injection) Injection, USP should be given to a pregnant woman only if clearly needed.

Nonteratogenic Effects

Anticholinesterase drugs may cause uterine irritability and induce premature labor when given intravenously to pregnant women near term.

Nursing Mothers

It is not known whether Neostigmine Methylsulfate (neostigmine methylsulfate (neostigmine methylsulfate injection) injection) is excreted in human milk.Because many drugs are excreted in human milk and because of the potential for serious adverse reactions from Neostigmine Methylsulfate (neostigmine methylsulfate (neostigmine methylsulfate injection) injection) in nursing infants, a decision should be made whether to discontinue nursing or to discontinue the drug, taking into account the importance of the drug to the mother.

Pediatric Use

Safety and effectiveness in children have not been established.

Last reviewed on RxList: 6/26/2008
This monograph has been modified to include the generic and brand name in many instances.