Neostigmine (Oral)

Neostigmine is used in the treatment of the muscular condition myasthenia gravis, which is an incurable condition that causes muscle weakness that worsens with activity.


Neostigmine is an oral treatment prescribed as Prostimin Bromide tablets to treat a certain muscular condition.

Neostigmine is used to control the symptoms of myasthenia gravis. Myasthenia gravis is an incurable disease but the use of treatments such as Neostigmine allows the condition to be controlled and patients can enjoy a normal life expectancy. The condition is a chronic autoimmune and neuromuscular disease. It will cause problems with breathing and with arms and legs if untreated. The most commonly recognized symptom is a loss of control of facial muscles.

Neostigmine is available only with a prescription and is taken in tablet form by the patient. Regular use is imperative in controlling the condition.

Condition treated

  • Myasthenia gravis, symptoms of

Type Of Medicine

  • Acetylcholinesterase inhibitor

Side Effects

In addition to the required effects occurring from the use of Neostigmine, other unwanted effects can also occur. While not all of these side effects may occur, in some cases they may require that you seek medical attention.

You should consult your doctor immediately if you experience any of the following side effects form the use of this medication:

  • Blurring or loss of vision
  • Ceased blood pressure
  • Ceased pulse
  • Changed color perception
  • Changed patterns and/or rhythms of speech
  • Chest discomfort
  • Chest pains
  • Confusion or disorientation
  • Coughing
  • Difficult breathing
  • Difficulty with movements
  • Difficulty with swallowing
  • Doubling of vision
  • Faintness when rising suddenly from a sitting or lying position
  • Fast or pounding heartbeat
  • Fast or slow breathing
  • Halos seen around lights
  • Hives
  • Irregular heartbeat
  • Irregularity of breath
  • Irregularity of heartbeat or pulse
  • Itching
  • Labored breathing
  • Lightheadedness, dizziness or faintness
  • Loss of consciousness or changed consciousness
  • Muscle cramping
  • Muscle pain
  • Muscle spasms
  • Muscle stiffness
  • Muscle twitching that is visible under the skin
  • Night blindness
  • Overbright appearance of lights
  • Pain in the joints
  • Paleness or bluish tint of the lips, fingernails or skin
  • Puffing or selling around eyes, face, lips or tongue
  • Puffy or swollen appearance of the eyelids
  • Seizures or convulsions
  • Shortness of breath
  • Skin rash
  • Slowed heartbeat
  • Slurring of speech
  • Stopped heart
  • Sweating
  • Tightness across the chest
  • Trouble with speaking
  • Tunneling of vision
  • Unconsciousness
  • Unusual tiredness
  • Unusual weakness
  • Unusually audible breathing
  • Wheezing

It is possible to overdose on this medication. If you believe that you or someone else has taken an overdose of this treatment then you should contact the emergency services immediately. The symptoms of overdose can include the following:

  • Constipation
  • Decrease in sexual ability or performance
  • Difficulty with urination
  • Dryness of the mouth
  • Enlargement of pupils
  • Weakness of the muscles

Some other side effects can also occur that would not normally require you to seek medical attention. These side effects may abate over time as your body adapts to the medication. If these side effects are bothersome and continuing then you may seek advice from your healthcare professional as to how you can alleviate them:

  • Bloating
  • Constricted pupils
  • Diarrhea
  • Drowsiness
  • Excess build up of gas in the stomach or the intestines
  • Feeling full
  • Feeling of warmth
  • Headaches
  • Increase in sweating when cool
  • Increase in the amount of mucous produced by the lungs
  • Increase in watering of the mouth
  • Increased in the need to urinate
  • More frequent passing of urine
  • Nausea
  • Passing of gas
  • Redness of the face, neck, arms and occasionally sometimes the upper chest
  • Redness of the skin
  • Skin rash
  • Stomach cramping
  • Vomiting

Other side effects from the use of Neostigmine could also occur. If you notice other side effects occurring then you should consult your healthcare professional for advice on how to react.


You must keep a record of the doses of this medication that you take and how long each dose lasts. Your doctor will advise you on how to do this effectively. Accurate recordings will help your doctor adjust your dose to get the best effect for you.

The dose of this medication will vary dramatically between patients. There are a number of factors that will effect the dose given including age, condition, weight and other factors personal to each patient. You should only ever take this medication as it has been prescribed to you by your doctor and should not ever adjust the dose without being instructed to do so. The following dosing information is for the purposes of being an approximate guide only and should not be used to adjust the dose of medication that you take.

Adults should be treated with a dose between 15-375mg taken each day. The dose should be divided into smaller doses for use. The doctor will determine the appropriate dose for you and may make regular changes to the dose given.

If you miss a dose of this treatment then you should take it as soon as you are able to. If you are close to your next dose, however, then you should skip it and go back to your usual schedule of dosing. Never take a double dose of medication as this will put you at serious risk.


Some medications should never be used in conjunction with one another. Medications can interact with one another in the body and in some cases this can cause severe consequences to occur. In other cases medications may prevent one another from working and may increase the risk of certain side effects occurring. Before beginning treatment with Neostigmine you must inform your doctor of all medications that you are taking including any prescribed treatments, any over the counter medications and also any dietary supplements or herbal remedies you are taking. This is especially important in the following cases:

You should not usually take Neostigmine in conjunction with the following treatments. Your doctor may prescribe both but may need to adjust the dose that you are taking or adjust the frequency of use to reduce the risk:

  • Donepezil
  • Bupropion

The use of Neostigmine with the following medication can increase the likelihood or severity of certain side effects. You may be prescribed with both treatments but in these cases the doctor may adjust the dose or frequency of use of one or both treatments:

  • Succinylcholine

Interactions with other medications that have not been listed can also occur with Neostigmine.

Certain medical problems from which you suffer may also impact the use of this treatment. You should inform the doctor of all medications that you are taking before you begin use of this treatment. This is especially important in the following cases:

You should not use this treatment if you suffer from the following:

The following conditions could be worsened by the use of this treatment:

  • Asthma
  • Bradycardia
  • Recent heart attack
  • Problems with heart rhythm
  • Overactivity of the thyroid
  • Convulsions or seizures
  • Stomach ulceration

Other medical conditions may also impact on the use of Neostigmine. You must inform your doctor of all conditions from which you suffer.


Before beginning use of Neostigmine you must weigh the potential dangers of use against the benefits of using the treatment. You should consider everything herein with the doctor. The following factors in particular should be considered before use:

Allergies: You should inform your doctor if you have ever had a bad or unusual reaction to any medications in the past. Allergies to medications, foods, dyes, preservatives and other substances could prevent the use of this treatment so you should be clear if you have suffered from any reactions in the past.

Pediatric: This treatment has not been tested for use in children. You should discuss this with your doctor before use.

Geriatric: There is no information available on the use of this treatment in the elderly. Not limitations from use are expected to occur, however. Elderly patients will be more likely to have other conditions that could impact on the use of this medication.

Breastfeeding: Discuss breastfeeding during use with your doctor. The risks should be weighed against the benefits of continuing to breastfeed.

Pregnancy: The risk of using this treatment during pregnancy cannot be ruled out. You must inform your doctor if you are pregnant before you use this medication. The risk has been categorized as level C. It should only be used when the treatment is clearly needed.

Your doctor will need to see you regularly to check your progress when using this medication.

If your symptoms do not improve through use then you should consult your doctor. Report any worsening of your condition to your doctor straight away.


You should store this medication out of the reach of children at all times.

It can be stored at room temperature as long as you keep it away from heat, moisture and direct light. You should also prevent it from freezing.

You should not keep outdated or unneeded medication and must dispose of it properly as directed to by your doctor.


Neostigmine is used for the treatment of the symptoms of myasthenia gravis. Myasthenia gravis is a serious condition of the muscles and neurological system that is not curable. This progressive condition can cause breathing problems and other complications in the patient and will often lead to a loss of control of facial muscles. While Neostigmine is not a cure for the condition it will allow the patient to control the condition and patients can then enjoy a normal life expectancy with treatment.

It is important that doses of this medication are not missed as this will cause the symptoms to return. Patients should keep a log of the treatment that they use and when they use it so that the doctor can adjust the dose for best effect. Your doctor will explain how best to do this.