Neostigmine
743387
225095260
2008-07-11T21:19:29Z
194.32.41.72
/* Clinical Uses */
{{Drugbox|
|IUPAC_name = 3-(dimethylcarbamoyloxy)-N,N,N-trimethylbenzenaminium
| image = neostigmine.png
| CAS_number=59-99-4
| ATC_prefix=N07
| ATC_suffix=AA01
| ATC_supplemental={{ATC|S01|EB06}}
| PubChem=5824
| DrugBank=
| C = 12 | H = 19 | N = 2 | O = 2
| molecular_weight = 223.294 g/mol
| bioavailability= Unclear, probably less than 5%
| metabolism = Slow hydrolysis by acetylcholinesterase and also by plasma esterases
| elimination_half-life=50–90 minutes
| excretion =
| pregnancy_category =
| legal_status =
| routes_of_administration=
| excretion = Unchanged drug (up to 70%) and alcoholic metabolite (30%) are excreted in the urine
}}
'''Neostigmine''' is a [[parasympathomimetic]], specifically, a reversible [[cholinesterase inhibitor]]. By interfering with the breakdown of [[acetylcholine]], neostigmine indirectly [[agonist|stimulates]] both [[nicotinic acetylcholine receptor|nicotinic]] and [[muscarinic acetylcholine receptor|muscarinic receptor]]s. It does cross the [[blood-brain barrier]] albeit poorly. Neostigmine binds to the anionic site of cholinesterase. The drug blocks the active site of acetylcholinesterase so the enzyme can no longer break down the acetylcholine molecules before they reach the postsynaptic membrane receptors. This allows for the threshold to be reached so a new impulse can be triggered in the next neuron. In myasthenia gravis there are too few acetylcholine receptors so with the acetylcholinesterase blocked, acetylcholine can bind to the few receptors and trigger a muscular contraction.
==Clinical Uses==
It is used to improve muscle tone in people with [[myasthenia gravis]] and routinely, in [[anesthesia]] at the end of an operation, to reverse the effects of non-[[depolarization|depolarizing]] [[muscle relaxant]]s such as [[rocuronium]] and [[vecuronium]].
It can also be used for [[urinary retention]] resulting from [[general anesthetic|general anaesthesia]] and to treat [[curare|curariform]] drug toxicity.
Another indication for use is the [[Ogilvie syndrome]] which is a pseudoobstruction of the colon in critically ill patients.
Neostigmine will cause slowing of the heart rate ([[bradycardia]]), for this reason it is usually given along with a [[parasympatholytic]] drug such as [[atropine]] or [[glycopyrrolate]].
Neostigmine is available under several trade names such as '''Prostigmin'''.
Neostigmine was first synthesized by Aeschlimann and Reinert in 1931.
Though only one of two treatments available for Myasthenia Gravis this drug is no longer available to anyone using the Medicare Part D program.
==Sources==
*Brenner, G. M. (2000). ''Pharmacology.'' Philadelphia, PA: W.B. Saunders Company. ISBN 0-7216-7757-6
*Canadian Pharmacists Association (2000). Compendium of Pharmaceuticals and Specialties (25th ed.). Toronto, ON: Webcom. ISBN 0-919115-76-4
{{Parasympathomimetics}}
{{Anticholinesterases}}
{{Antiglaucoma preparations and miotics}}
[[Category:Anticholinesterases]]
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