Description:

Neostigmine Methylsulphate Injection IP (brand Myostigmin 5ml) is a cholinesterase inhibitor used to treat myasthenia gravis (a neuromuscular disorder causing muscle weakness and fatigue), reverse the effects of non-depolarizing neuromuscular blocking agents after surgery (to restore muscle function), treat postoperative urinary retention and paralytic ileus (intestinal atony), and manage certain other conditions involving smooth or skeletal muscle weakness. The 5ml ampoule typically contains 2.5mg neostigmine methylsulfate (0.5mg/ml concentration). It is a prescription injectable commonly used in hospitals for anaesthesia reversal and myasthenia management.

Prescription:

Prescription-only (requires a doctor’s prescription in Ghana; administered by healthcare professionals via IV/IM/SC injection in hospitals/clinics; not for self-administration or OTC dispensing due to risks like cholinergic crisis and need for atropine co-administration in some uses).

Therapeutic Category:

Cholinesterase Inhibitor / Parasympathomimetic (Anticholinesterase agent).

Active Ingredients/Composition:

• Active ingredient: Neostigmine methylsulfate IP – 2.5 mg per 5 ml ampoule (0.5 mg/ml). Other ingredients: Water for injection, methylparaben and propylparaben (preservatives in some formulations), sodium acetate trihydrate, and pH adjusters (acetic acid/sodium hydroxide). The solution is clear, colorless to pale yellow, sterile, and ready-to-use.

Vitamins: None.

Minerals: None.

Variant:

• Myostigmin 2.5mg/5ml Injection (standard 5ml ampoule with 0.5mg/ml concentration). Related variants: Myostigmin 0.5mg/ml in 10ml vials (lower concentration for multi-dose), or other neostigmine brands (e.g., Prostigmin). The 5ml ampoule is the common single-dose variant for reversal or diagnostic use.

Consume Type:

Injectable – Intravenous (IV), Intramuscular (IM), or Subcutaneous (SC) injection (administered only by healthcare professionals; slow IV to avoid cholinergic effects).

Directions/Usage: Administered only in clinical settings.

• Reversal of neuromuscular blockade: 0.5–2.5 mg IV (slow, over 1 minute) with atropine (0.6–1.2 mg IV) or glycopyrronium to counteract muscarinic effects; repeat if needed.
• Myasthenia gravis (acute): 0.5–2.5 mg IM/SC; maintenance adjusted.
• Postoperative urinary retention/paralytic ileus: 0.5–2.5 mg IM/SC.
• Diagnostic test for myasthenia: 1–2 mg IM/SC with atropine cover.
• Dose adjusted for age, weight, and response; maximum single dose often 5 mg.
• Always co-administer atropine/glycopyrronium for IV use to prevent bradycardia/salivation.

Common Side Effects: Common (muscarinic/cholinergic):

• Increased salivation, sweating, nausea, vomiting.
• Abdominal cramps, diarrhoea.
• Bradycardia (slow heart rate).
• Miosis (pupil constriction), blurred vision.
• Muscle fasciculations or weakness (if overdose). Rare/serious (seek immediate help): Cholinergic crisis (severe weakness, respiratory failure), anaphylaxis, seizures, or arrhythmias.

Package Type:

Glass ampoules of 5ml (each containing 2.5mg neostigmine methylsulfate; packs of 5 or 10 ampoules; labelled carton with instructions).

Storage Advice: Store at room temperature (below 25–30°C) in original packaging, protected from light. Do not freeze. Keep out of reach of children.

Safety Advice:

• Administered only under medical supervision (risk of cholinergic crisis – monitor respiratory rate, heart rate, and reflexes).
• Contraindicated in hypersensitivity to neostigmine, peritonitis, urinary/intestinal obstruction, or without atropine cover for IV use.
• Caution in asthma (bronchospasm risk), bradycardia, epilepsy, or peptic ulcer.
• Atropine/glycopyrronium must be available to counteract muscarinic effects.
• If severe weakness, breathing difficulty, excessive salivation, or bradycardia occurs, stop use and give atropine.
• Keep out of reach of children (overdose risk).

Product Substitutes: Similar neostigmine methylsulfate injections in Ghana include:

• Generic neostigmine 0.5mg/ml or 2.5mg/5ml injection (various importers).
• Myostigmin (Neon Laboratories brand, 0.5mg/ml or 2.5mg/5ml).
• Prostigmin (original brand if stocked). Alternatives: Edrophonium (for diagnostic testing), pyridostigmine (oral for myasthenia maintenance). Consult anesthesiologist or neurologist in Accra (e.g., Korle Bu Hospital) for alternatives.

Manufacturer/Marketer:

NFON Laboratories Ltd or Neon Laboratories Ltd (India-based; Myostigmin is a common brand by Neon Laboratories; NFON may be a variant or distributor branding). Marketed/distributed in Ghana by local importers/pharmacies (widely stocked as imported generic).

Country of Origin:

India (manufactured by Neon Laboratories Ltd or similar Indian company; imported to Ghana and available in local pharmacies/hospitals).