Long COVID Patterns in the RECOVER-Adult Study
November 21, 2025
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Brand Name :
Prostigmin, Bloxiverz
Synonyms :
neostigmine
Class :
Acetylcholinesterase Inhibitors, Miscellaneous genitourinary tract agents
Brand Name :
Prostigmin, Bloxiverz
Synonyms :
neostigmine
Class :
Acetylcholinesterase Inhibitors, Miscellaneous genitourinary tract agents
Dosage Forms & StrengthsÂ
Injectable solution Â
0.5mg/mlÂ
1mg/mlÂ
Tablet Â
15 mgÂ
Administer dose of 0.5 to 2.5 mg subcutaneously/intramuscularly/ intravenously every day
Take a maintenance dose of 15 to 375 mg daily orally divided every 6 to 8 hours
Administer injectable containing 0.6 to 1.2 mg of atropine intravenously to counteract the muscarinic effects
Dose of 0.03 to 0.07 mg/kg intravenous will typically result in a train-of-four twitch ratio of 90% within 10 to 20 minutes of administration
Dose not more than 0.07 mg/kg or a cumulative total of 5 mg whichever dose is smaller from these is to be injected by slow intravenous for minimum 1 minute
For Prevention:
Administer dose of 0.25 mg intramuscularly once surgery completed
Repeat this every 4 to 6 hours for next 2 to 3 days
For Treatment:
Administer dose of 0.5 to 1 mg intramuscularly and up to every 3 hours as needed
Administration
Intravenous train-of-four monitoring for Neuromuscular Blockade reversal:
Peripheral nerve stimulation devices capable of producing a train-of-four stimulus are required to effectively and safely regulate intravenous dose
Dosage Forms & StrengthsÂ
Injectable solutionÂ
0.5mg/mlÂ
1mg/mlÂ
Tablet Â
15 mgÂ
Use this with atropine drug
Administer dose of 0.01 to 0.04 mg/kg subcutaneously/intramuscularly/ intravenously every 2 to 3 hours as needed
Take a dose of 2 mg/kg daily orally divided every 4 hour and maximum dose up to 375 mg in a day
Dose of 0.03 to 0.07 mg/kg intravenous will typically result in a train-of-four twitch ratio of 90% within 10 to 20 minutes of administration
Dose not more than 0.07 mg/kg or a cumulative total of 5 mg whichever dose is smaller from these is to be injected by slow intravenous for minimum 1 minute
Administration
Intravenous train-of-four monitoring for Neuromuscular Blockade reversal:
Peripheral nerve stimulation devices capable of producing a train-of-four stimulus are required to effectively and safely regulate intravenous dose
Refer to adult dosingÂ
may have an increased constipating effect when combined with clozapine
may have an increased anticholinergic effect when combined with glycopyrrolate
zolpidem: they may decrease the therapeutic effect of anticholinesterases
may have an increased anticholinergic effect when combined with cimetropium
may have an increased constipating effect when combined with eluxadoline
may have an increased anticholinergic effect when combined with anticholinergic agents
may increase the anticholinergic effect of Anticholinergic Agents
anticholinergic agents increase the ulcer-producing effect of potassium citrate
may increase the anticholinergic effect of each other when combined
may have an increased anticholinergic effect when combined with anticholinergic agents
levosalbutamol: they may decrease the therapeutic effect of anticholinesterases
oxatomide: they may increase the anticholinesterase effect of anticholinesterases
may enhance the rate of excretion resulting in the lower serum level
may enhance the rate of excretion resulting in the lower serum level
may enhance the rate of excretion resulting in the lower serum level
may enhance the rate of excretion resulting in the lower serum level
may enhance the rate of excretion resulting in the lower serum level
may increase the effect of beta-blockers
may increase the effect of beta-blockers
may increase the effect of beta-blockers
may increase the effect of beta-blockers
may increase the effect of beta-blockers
may increase the effect of antipsychotic agents
may increase the effect of antipsychotic agents
may increase the effect of antipsychotic agents
may increase the effect of antipsychotic agents
may increase the effect of antipsychotic agents
may increase the effect of antipsychotic agents
may increase the effect of antipsychotic agents
may increase the effect of antipsychotic agents
may increase the effect of antipsychotic agents
may increase the effect of antipsychotic agents
may increase the effect of antipsychotic agents
may increase the effect of antipsychotic agents
may increase the effect of antipsychotic agents
may increase the effect of antipsychotic agents
may increase the effect of antipsychotic agents
may increase the effect of antipsychotic agents
may increase the effect of antipsychotic agents
may increase the effect of antipsychotic agents
may increase the effect of antipsychotic agents
may increase the effect of antipsychotic agents
may increase the effect of antipsychotic agents
may increase the effect of antipsychotic agents
may increase the effect of antipsychotic agents
reduce the therapeutic effect
reduce the therapeutic effect
reduce the therapeutic effect
reduce the therapeutic effect
reduce the therapeutic effect
may increase the neurotoxic effect
may increase the neurotoxic effect
may increase the neurotoxic effect
may increase the neurotoxic effect
may increase the neurotoxic effect
may increase the neurotoxic effect
may increase the neurotoxic effect
may increase the neurotoxic effect
may increase the neurotoxic effect
may increase the neurotoxic effect
may increase the neurotoxic effect
may increase the neurotoxic effect
may increase the neurotoxic effect
may increase the neurotoxic effect
may increase the neurotoxic effect
may increase the neurotoxic effect
may increase the neurotoxic effect
may increase the neurotoxic effect
may increase the neurotoxic effect
may increase the neurotoxic effect
may increase the neurotoxic effect
may increase the neurotoxic effect
may increase the neurotoxic effect
may increase the neurotoxic effect
may increase the neurotoxic effect
may increase the neurotoxic effect
may increase the neurotoxic effect
may increase the neurotoxic effect
may increase the bradycardic effect
may increase the bradycardic effect
may increase the bradycardic effect
may increase the bradycardic effect
may increase the bradycardic effect
may increase the bradycardic effect
may increase the bradycardic effect
may increase the bradycardic effect
may increase the bradycardic effect
may increase the bradycardic effect
they decrease the efficacy of gastrointestinal agents
they decrease the efficacy of gastrointestinal agents
they decrease the efficacy of gastrointestinal agents
they decrease the efficacy of gastrointestinal agents
they decrease the efficacy of gastrointestinal agents
may increase the risk of adverse effect
may increase the risk of adverse effect
may increase the risk of adverse effect
may increase the risk of adverse effect
may increase the risk of adverse effect
may enhance the adverse/toxic effect
may enhance the adverse/toxic effect
may enhance the adverse/toxic effect
may enhance the adverse/toxic effect
may enhance the adverse/toxic effect
may enhance the adverse/toxic effect
may enhance the adverse/toxic effect
may enhance the adverse/toxic effect
may enhance the adverse/toxic effect
may enhance the adverse/toxic effect
may enhance the adverse/toxic effect
may enhance the adverse/toxic effect
may enhance the adverse/toxic effect
may enhance the adverse/toxic effect
may enhance the adverse/toxic effect
may enhance the adverse/toxic effect
may enhance the adverse/toxic effect
may enhance the adverse/toxic effect
may enhance the adverse/toxic effect
may enhance the adverse/toxic effect
may enhance the adverse/toxic effect
may enhance the adverse/toxic effect
may enhance the adverse/toxic effect
may enhance the adverse/toxic effect
may enhance the adverse/toxic effect
may have an increasingly adverse effect when combined with other anticholinergic agents
may have an increasingly adverse effect when combined with other anticholinergic agents
may have an increasingly adverse effect when combined with other anticholinergic agents
may have an increasingly adverse effect when combined with other anticholinergic agents
may have an increasingly adverse effect when combined with other anticholinergic agents
spironolactone and hydrochlorothiazide
it increases the concentration of thiazide and its diuretics in the serum
it increases the concentration of thiazide and its diuretics in the serum
it increases the concentration of thiazide and its diuretics in the serum
it increases the concentration of thiazide and its diuretics in the serum
it increases the concentration of thiazide and its diuretics in the serum
may decrease the therapeutic effect when combined with anticholinergic agents
may decrease the therapeutic effect when combined with anticholinergic agents
may have an increased tachycardic effect when combined with cannabinoid products
may have an increased tachycardic effect when combined with cannabinoid products
may have an increasingly adverse effect when combined with opioid agonists
may have an increasingly adverse effect when combined with opioid agonists
may have an increasingly adverse effect when combined with opioid agonists
may have an increasingly adverse effect when combined with opioid agonists
anticholinestereses: they may increase the toxic effect of mu-opioid receptor agonists
anticholinestereses: they may increase the toxic effect of mu-opioid receptor agonists
It may enhance the risk of adverse effects when combined with anticholinesterases
may have an increasingly adverse effect when combined with other anticholinergic agents
may decrease the therapeutic effect when combined with gastrointestinal agents
may decrease the therapeutic effect when combined with gastrointestinal agents
may have an increasingly adverse effect when combined with opioid agonists
may have an increasingly adverse effect when combined with opioid agonists
may have an increasingly adverse effect when combined with opioid agonists
may have an increasingly adverse effect when combined with opioid agonists
may have an increasingly adverse effect when combined with opioid agonists
may enhance the concentration of serum when combined with thiazide diuretics
may enhance the concentration of serum when combined with thiazide diuretics
may have a decreased therapeutic effect when combined with anticholinergic agents
may decrease the therapeutic effect when combined with gastrointestinal agents
may decrease the therapeutic effect when combined with gastrointestinal agents
amoxicillin/omeprazole/rifabutin
may decrease the therapeutic effect when combined with gastrointestinal agents
may decrease the therapeutic effect when combined with gastrointestinal agents
may decrease the therapeutic effect when combined with anticholinergic agents
may decrease the therapeutic effect when combined with anticholinergic agents
may enhance the risk of adverse effect of acetylcholinesterase inhibitors
may enhance the risk of adverse effect of acetylcholinesterase inhibitors
may enhance the risk of adverse effect of acetylcholinesterase inhibitors
may enhance the risk of adverse effect of acetylcholinesterase inhibitors
may enhance the risk of adverse effect of acetylcholinesterase inhibitors
may enhance the risk of adverse effect of acetylcholinesterase inhibitors
may enhance the risk of adverse effect of acetylcholinesterase inhibitors
may enhance the risk of adverse effect of acetylcholinesterase inhibitors
may enhance the risk of adverse effect of acetylcholinesterase inhibitors
may enhance the risk of adverse effect of acetylcholinesterase inhibitors
may enhance the risk of adverse effect of acetylcholinesterase inhibitors
may enhance the risk of adverse effect of acetylcholinesterase inhibitors
may enhance the risk of adverse effect of acetylcholinesterase inhibitors
may enhance the risk of adverse effect of acetylcholinesterase inhibitors
may enhance the risk of adverse effect of acetylcholinesterase inhibitors
may enhance the risk of adverse effect of acetylcholinesterase inhibitors
may enhance the risk of adverse effect of acetylcholinesterase inhibitors
may enhance the risk of adverse effect of acetylcholinesterase inhibitors
may enhance the risk of adverse effect of acetylcholinesterase inhibitors
may enhance the risk of adverse effect of acetylcholinesterase inhibitors
may enhance the risk of adverse effect of acetylcholinesterase inhibitors
may enhance the risk of adverse effect of acetylcholinesterase inhibitors
may enhance the risk of adverse effect of acetylcholinesterase inhibitors
may enhance the risk of adverse effect of acetylcholinesterase inhibitors
may enhance the risk of adverse effect of acetylcholinesterase inhibitors
may enhance the risk of adverse effect of acetylcholinesterase inhibitors
may have an increased anticholinergic effect when combined with anticholinergic agents
may enhance the anticholinergic effect of Anticholinergic agents
may increase the anticholinergic effect of anticholinergic agents
promethazine/dextromethorphanÂ
may increase the toxic effect of other Anticholinergic Agents
may diminish the absorption when combined with nitroglycerin
may have an increasingly adverse effect when combined with glucagon
anticholinergic agents increase the toxicity of topiramate
may increases the adverse effect of Opioid Agonists
buprenorphine,long-acting injectionÂ
may increases the adverse effect of Opioid Agonists.
acetaminophen/doxylamine/dextromethorphanÂ
may increase the adverse effect of other Anticholinergic Agents
may enhance the adverse/toxic effect
may enhance the adverse/toxic effect
may enhance the adverse/toxic effect
may enhance the adverse/toxic effect
may enhance the adverse/toxic effect
may enhance the adverse/toxic effect
may enhance the adverse/toxic effect
may enhance the adverse/toxic effect
may enhance the adverse/toxic effect
may enhance the adverse/toxic effect
may enhance the risk of adverse effect
may enhance the risk of adverse effect
may enhance the risk of adverse effect
may enhance the risk of adverse effect
may enhance the risk of adverse effect
may enhance the risk of adverse effect
may enhance the risk of adverse effect
may enhance the risk of adverse effect
may enhance the risk of adverse effect
may enhance the risk of adverse effect
may have an increasingly adverse effect when combined with other anticholinergic agents
may have an increasingly adverse effect when combined with other anticholinergic agents
may have an increasingly adverse effect when combined with other anticholinergic agents
may have an increasingly adverse effect when combined with other anticholinergic agents
may have an increasingly adverse effect when combined with other anticholinergic agents
may diminish the therapeutic effect of Acetylcholinesterase Inhibitors
may decrease the therapeutic effect of Acetylcholinesterase Inhibitors
may decrease the therapeutic effect of Acetylcholinesterase Inhibitors
It may enhance the risk of adverse effects when combined with hormone antagonists
may decrease the therapeutic effect when combined with anticholinergic agents
may have an increasingly adverse effect when combined with other anticholinergic agents
may have an increased tachycardic effect when combined with cannabinoid products
may have an increased tachycardic effect when combined with cannabinoid products
may enhance the serum concentration of anticholinergic agents
may enhance the serum concentration of anticholinergic agents
may increase the efficacy of each other when combined
may enhance the risk of hypertension when combined
may enhance the risk of hypertension when combined
may enhance the risk of hypertension when combined
may enhance the risk of hypertension when combined
may enhance the risk of hypertension when combined
the anticholinergic effect of chlorprothixene may be enhanced by anticholinergic agents
When neostigmine is used together in combination with profenamine, this leads to reduction in therapeutic effectiveness of profenamine
anticholinergic agents decrease the efficacy of secretin
Actions and SpectrumÂ
neostigmine reversibly inhibits acetylcholinesterase, the enzyme responsible for breaking down acetylcholine. Â
By inhibiting this enzyme, it prolongs the action of acetylcholine, which enhances its effects on muscle cells.Â
Frequency not defined Â
Drowsiness, headache Â
DysarthriaÂ
Allergic reactions and anaphylaxisÂ
Dizziness Â
Loss of consciousnessÂ
ConvulsionsÂ
Miosis and visual changesÂ
Cardiac arrhythmiasÂ
Increased oralÂ
Respiratory depressionÂ
Rash and urticariaÂ
Pharyngeal and bronchial secretionsÂ
ArthralgiaÂ
DiaphoresisÂ
DyspneaÂ
Increased peristalsis and salivationÂ
Urinary frequencyÂ
NauseaÂ
Emesis Â
FlatulenceÂ
Muscle cramps and spasms Â
Flushing and weaknessÂ
Black Box WarningÂ
None
Contraindication/Caution:Â
Contraindication:Â
Caution:Â
Pregnancy consideration:Â
Pregnancy category: N/AÂ
Lactation: Excretion into human milk is unknown Â
Pregnancy Categories:        Â
Category A: well-controlled and Satisfactory studies show no risk to the fetus in the first or later trimester.Â
Category B: there was no evidence of risk to the fetus in animal studies, and there were not enough studies on pregnant women. Â
Category C: there was evidence of risk of adverse effects in animal reproduction studies, and no adequate evidence in human studies must take care of potential risks in pregnant women.Â
Category D: adequate data with sufficient evidence of human fetal risk from various platforms, but despite the potential risk, and used only in emergency cases for potential benefits.Â
Category X: Drugs listed in this category outweigh the risks over benefits. Hence these categories of drugs need to be avoided by pregnant women.Â
Category N: There is no data available for the drug under this category.Â
Pharmacology Â
neostigmine works by inhibiting the activity of acetylcholinesterase (AChE), an enzyme responsible for breaking down acetylcholine.Â
AChE rapidly breaks it down to terminate the signal and prevent continuous muscle contraction. Â
PharmacodynamicsÂ
Limited information available Â
PharmacokineticsÂ
Absorption  Â
The bioavailability of orally administered neostigmine is low due to significant first-pass metabolism in the liver. Â
DistributionÂ
neostigmine has a relatively small volume of distribution.Â
MetabolismÂ
neostigmine undergoes metabolism in the liver.Â
Elimination and excretionÂ
neostigmine and its metabolites occur mainly via the kidneys through renal excretion.
AdministrationÂ
neostigmine can be administered through various routes such as intravenously, subcutaneous and intramuscular Injection. Â
neostigmine also administered orally in the form of tablets. Â
Patient information leafletÂ
Generic Name: neostigmineÂ
Why do we use neostigmine?Â
neostigmine is used for managing myasthenia gravis, an autoimmune neuromuscular disorder. Â
neostigmine is used to reverse the effects of non-depolarizing neuromuscular-blocking agents that are used during surgery to induce muscle relaxation. Â
neostigmine can be used to stimulate the bladder muscles and facilitate urination in postoperative urinary retention.Â
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