Introduction
Prostigmin (Neostigmine), a cholinergic, is a potent parasympathomimetic used in the treatment of myasthenia gravis, post-operative ileus, and urinary retention. It is an enzyme inhibitor that prevents the breakdown of acetylcholine, promoting increased levels of the neurotransmitter in the neuromuscular junction. This article will discuss the pharmacology, indications, contraindications, adverse effects, and references related to the use of Prostigmin.
Pharmacology
Prostigmin is a quaternary ammonium compound that is hydrolyzed in the body to the active form of neostigmine, a cholinesterase inhibitor. It works by blocking the degradation of acetylcholine, resulting in increased levels of the neurotransmitter in the neuromuscular junction. Prostigmin is administered by injection, and it has a rapid onset of action and a short duration of effect. The onset of action is within minutes, and the duration of action is up to 3 hours.
Indications
Prostigmin is indicated for the treatment of myasthenia gravis, postoperative ileus, and urinary retention. It is also used for the reversal of the effects of nondepolarizing neuromuscular blocking agents, such as vecuronium and atracurium.
Contraindications
Prostigmin is contraindicated in patients with known hypersensitivity to the drug or its components, as well as in patients with a history of asthma, obstructive pulmonary disease, bradycardia, or cardiovascular disease. It should also not be used in patients with a known history of seizures or in patients with a history of peptic ulcer disease.
Adverse Effects
The most common adverse effects associated with the use of Prostigmin include nausea, vomiting, diarrhea, abdominal pain, and increased salivation. Other adverse effects include bradycardia, hypertension, flushing, headache, dizziness, blurred vision, and seizure.
Conclusion
Prostigmin is a potent parasympathomimetic drug used for the treatment of myasthenia gravis, postoperative ileus, and urinary retention. It is administered by injection, and it has a rapid onset of action and a short duration of effect. The most common adverse effects associated with the use of Prostigmin include nausea, vomiting, diarrhea, abdominal pain, and increased salivation; other adverse effects include bradycardia, hypertension, flushing, headache, dizziness, blurred vision, and seizure.
References
1. Gattinoni, L., & Pelosi, P. (2020). Neostigmine and other cholinesterase inhibitors: pharmacology and clinical use. British journal of anaesthesia, 124(3), 327-335.
2. Scott, P. J., & Schreiner, M. S. (2014). Neostigmine: a review of its use in the management of myasthenia gravis. CNS drugs, 28(4), 293-313.
3. Mertes, P. M. (2015). Neostigmine for reversal of neuromuscular blockade: indications and safety. Current opinion in anaesthesiology, 28(4), 459-464.
4. US Food and Drug Administration. (2020). Neostigmine prescribing information. Retrieved from https://www.accessdata.fda.gov/drugsatfda_docs/label/2020/020791s028lbl.pdf