neostigmine methylsulfate 5mg 500 2


Prefilled O.R. anesthesia syringes are an excellent solution enabling your facility to reduce waste and improve efficiency.  Edge Pharma provides the added comfort of knowing that your compounded outsourced medications are being produced in a CGMP compliant facility where every batch completes potency, endotoxin, and 14-day sterility testing prior to release.


Neostigmine Methylsulfate

 Room temperature storage.

  • Neostigmine Unit Dose Syringe - 5 mg / 5 mL (1mg/mL)


Literature Review


Neostigmine and NMBA

Neostigmine is classified as an acetylcholinesterase inhibitor and is often used for the reversal of the effects of neuromuscular blocking agents (NMBA) after surgery, according to an article published in the National Library of Medicine, of the National Institute of Health. The article continues, “After administration of neostigmine, the concentration of acetylcholine is increased in the neuromuscular junction which allows for muscles to contract with full strength and patients can breathe spontaneously and protect their airways safely after emergence from anesthesia.”(1)

Many anesthesiologists use neostigmine to avoid having patients experience muscle weakness that can lead to adverse events after surgery. “The use of neostigmine significantly reduces the risk that patients will be left with muscle weakness in the recovery room,” according to an article published in the U.S. National Library of Medicine.2 The article described a study aimed at determining whether neostigmine use is associated with muscle weakness when it is given at the time of nearly complete recovery from NMBA.(2)

The study description stated, “Surprisingly, some investigators have reported that neostigmine-induced muscle weakness may occur if the drug is given when the effect of the NMBA has completely worn off.” The doubled-blinded randomized trial included 120 surgery patients who required intubation. The study found:

• “In this randomized trial of patients achieving a train-of-four ratio of 0.9 or greater, half received either neostigmine 40 μg/kg or saline (control)”

• “There was no difference between groups in train-of-four ratios minutes after reversal or on recovery room admission and no difference in the incidence of postoperative muscle weakness, hypoxemia, or airway obstruction”

• “Anticholinesterases should be routinely administered after neuromuscular blockade, without fear of causing muscle weakness, unless full neuromuscular recovery has been documented with quantitative monitoring”(3)

Myasthenia Gravis is a disease marked by fatigue and weakness of the voluntary muscles because of a breakdown in communication between nerve endings and adjoining muscle fibers.(4) The Myasthenia Gravis Foundation of America reports that in the U.S. between 14 and 20 out of 100,000 individuals have Myasthenia Gravis (MG), but since the disease is often underdiagnosed, the prevalence is likely higher.(5)

Neostigmine is one of the cholinesterase inhibiting drugs used to treat MG. While these medications are not a cure for the disease, they enhance communication between nerves and muscles, improving muscle contraction and strength in some patients.(6)

(1) Neely, Grant A., Kohli, Arpan, National Library of Medicine, National Institute of Health, “Neostigmine,”
(2) Murphy, Glenn S. M.D., Northshore University HealthSystem, U.S. National Library of Medicine, online article, “Neostigmine Reversal and Neuromuscular Recovery,”
(3) Murphy, Glenn S. M.D., Anesthesiology: The Journal of the American Society of Anesthesiologists, online article, “Neostigmine Administration after Spontaneous Recovery to Train-of-Four of 0.9 to 1.0: A Randomized Controlled Trial of the Effect on Neuromuscular and Clinical Recovery,”
(4) “Myasthenia Gravis,” online article, Cleveland Clinic,
(5) “Myasthenia Gravis,” online article, The Myasthenia Gravis Foundation of America,
(6) “Myasthenia Gravis: Diagnosis and Treatment” online article, The Mayo Clinic,


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