Posology : מינונים

4.2 Posology and method of administration

Neostigmine methylsulphate should be given very slowly by the IV route.
A syringe of atropine sulphate should always be available to counteract severe cholinergic reactions should they occur.

Myasthenia gravis: 1 – 2.5 mg by IM or SC injection at intervals throughout the day, when maximum strength is needed. The usual duration of action of a dose is two to four hours. The total daily dose is usually 5 – 20 mg by injection but higher doses may be needed by some patients.
Neonatal myasthenia gravis may be treated with 0.1 mg neostigmine intramuscularly initially. Thereafter, the dose must be titrated individually.
But is usually 0.05 – 0.25 mg IM or 0.03 mg/kg IM, every two – four hours. Because of the self-limiting nature of the disease in neonates, the daily dosage should be reduced until the drug can be withdrawn.

Older Children: (Under 12 years of age) May be given 0.2 – 0.5 mg by injection as required. Dosage requirements should be adjusted according to the response of the patient.

Antagonist to Non-depolarizing Neuromuscular Blockade: Reversal of neuromuscular blockade with Neostigmine should not be attempted unless there is spontaneous recovery from paralysis.

Adults and Children: A single dose of neostigmine 0.05 – 0.07 mg/kg body-weight and Atropine 0.02 – 0.03 mg/kg body weight, by slow IV injection over one minute is usually adequate for complete reversal of Non-depolarizing Muscle Relaxants within 5 – 15 minutes. The maximum recommended dose of neostigmine in adults is 5 mg and in children     2.5 mg.

Atropine and neostigmine may be given simultaneously, but in patients with bradycardia, the pulse rate should be increased to 80 per minute with atropine before administering neostigmine.

Paralytic Ileus

Adults: 0.5 – 2.5 mg Neostigmine methylsulphate by SC or IM injection.
Children: 0.125 – 1 mg by injection. Doses may be varied according to the individual needs of the patient.

Elderly: There are no specific dosage recommendations for neostigmine methylsulphate in the elderly.