Instigmine

Instigmine Uses, Dosage, Side Effects, Food Interaction and all others data.

Instigmine is a parasympathomimetic, specifically, a reversible cholinesterase inhibitor. By interfering with the breakdown of acetylcholine, Instigmine indirectly stimulates both nicotinic and muscarinic receptors. It does cross the blood-brain barrier but only poorly. Instigmine 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.

Instigmine is a cholinesterase inhibitor used in the treatment of myasthenia gravis and to reverse the effects of muscle relaxants such as gallamine and tubocurarine. Instigmine, unlike physostigmine, does not cross the blood-brain barrier. By inhibiting acetylcholinesterase, more acetylcholine is available in the synapse, therefore, more of it can bind to the fewer receptors present in myasthenia gravis and can better trigger muscular contraction.

Trade Name Instigmine
Availability Prescription only
Generic Neostigmine
Neostigmine Other Names Eustigmin, Eustigmine, Neostigmina
Related Drugs pyridostigmine, bethanechol, Mestinon, Soliris, Vyvgart, Ultomiris, sugammadex, Urecholine, eculizumab, Bridion
Weight 0.5mg/ml, 2.5mg/ml
Type Injection
Formula C12H19N2O2
Weight Average: 223.2915
Monoisotopic: 223.144652862
Protein binding

Protein binding to human serum albumin ranges from 15 to 25 percent.

Groups Approved, Vet approved
Therapeutic Class Anti-cholinesterases, Drugs used in Myasthenia Gravis
Manufacturer Indus Pharma (pvt) Ltd,
Available Country Pakistan
Last Updated: September 19, 2023 at 7:00 am
Instigmine
Instigmine

Uses

Instigmine Methyl Sulphate is used for-

  • Reversal of nondepolarising neuromuscular blockade for surgical anesthetic procedures
  • The prevention and treatment of post-operative abdominal distention and urinary retention after mechanical obstruction has been excluded.
  • Treatment of the systemic control of Myasthenia Gravis when oral therapy is impractical.

Instigmine is also used to associated treatment for these conditions: Curarization therapy, Myasthenia Gravis, Neuromuscular Blockade, Ogilvie's syndrome, Postoperative Urinary Retention, Post-operative intestinal atony

How Instigmine works

Instigmine is a parasympathomimetic, specifically, a reversible cholinesterase inhibitor. The drug inhibits acetylcholinesterase which is responsible for the degredation of acetylcholine. So, with acetylcholinesterase inhibited, more acetylcholine is present By interfering with the breakdown of acetylcholine, neostigmine indirectly stimulates both nicotinic and muscarinic receptors which are involved in muscle contraction.. It does not cross the blood-brain barrier.

Dosage

Instigmine dosage

Reversal of the effects of Non-depolarizing Neurormuscular Blocking Agents: The usual dose is 0.5 to 2 mg given by slow intravenous injection over 60 seconds; repeated as required. Total dose should not exceed 5 mg (in exceptional cases). When Instigmine is administered intravenously, it is recommended that Atropine Sulphate (0.6-1.2 mg) also be given intravenously using separate syringe.

Prevention of post-operative abdominal distention and urinary retention: 0.25 mg intramuscularly or subcutaneously as soon as possible after operation; repeat every 4 6 hours for 2-3 days.

Treatment of post-operative abdominal distention: 0.5 mg intramuscularly or subcutaneously or as required.

Treatment of urinary retention: 0.5 mg intramuscularly or subcutaneously. If urination does not occur within an hour, the patient should be catheterized. After the patient has voided, or the bladder has been emptied, continue the 0.5 mg injection every 3 hours, for at least 5 injections.

Symptomatic control of Myasthenia Gravis: 0.5 mg intramuscularly or subcutaneously. Subsequent dose should be based on the individual patient's response.

Neonates: 50-250 micrograms (0.1 to 0.5 ml) every 4 hours.

Children: 200-500 micrograms (0.4 ml to 1 ml) as recommended.

Side Effects

Nausea, vomiting, increased salivation, diarrhoea and abdominal cramps (more marked with high doses). Signs of overdose are increased gastrointestinal discomfort, bronchial secretions and sweating, involuntary defecation and micturition, miosis, nystagmus, bradycardia, hypotension, agitation, excessive dreaming and weakness eventually leading to fasciculation and paralysis.

Toxicity

Overdosage of Instigmine can cause cholinergic crisis, which is characterized by increasing muscle weakness, and through involvement of the muscles of respiration, may result in death. The LD 50 of neostigmine methylsulfate in mice is 0.3 ± 0.02 mg/kg intravenously, 0.54 ± 0.03 mg/kg subcutaneously, and 0.395 ± 0.025 mg/kg intramuscularly; in rats the LD 50 is 0.315 ± 0.019 mg/kg intravenously, 0.445 ± 0.032 mg/kg subcutaneously, and 0.423 ± 0.032 mg/kg intramuscularly.

Precaution

Asthma, bradycardia, recent myocardial infarction, epilepsy, hypotension, parkinsonism, vagotonia, peptic ulceration. Atropine or other antidote to muscarinic effccts may be necessary (particularly when Instigmine is given by injection), but it should not be given routinely as it may mask signs of overdose.

Interaction

Anti-arrhythmic Procainamide, Quinidine and possibly Propafenone antagonise effect of Instigmine. Antibacterials, Aminoglycosides, Clindamycin, Lincomycin and Polymyxins antagonise effect of Instigmine.

Food Interaction

No interactions found.

Elimination Route

Instigmine bromide is poorly absorbed from the gastrointestinal tract following oral administration

Half Life

The half-life ranged from 42 to 60 minutes with a mean half-life of 52 minutes.

Pregnancy & Breastfeeding use

Pregnancy Category C. There are no adequate or well-controlled studies of Instigmine in either laboratory animals or in pregnantwomen. It is not known whether Instigmine can cause fetal harm when administered to a pregnant woman or can affect reproductive capacity. Instigmine should be given to a pregnant woman only if clearly needed.

Nonteratogenic Effects: Anticholinesterase drugs may cause uterine irritability and induce premature labor when given intravenously to pregnant women near term.

Nursing Mothers: It is not known whether Instigmine is excreted in human milk. Because many drugs are excreted in human milk and because of the potential for serious adverse reactions from Instigmine in nursing infants, a decision should be made whether to discontinue nursing or to discontinue the drug, taking into account the importance of the drug to the mother.

Contraindication

Instigmine is contraindicated in patients with known hypersensitivity to the drug. It is also contraindicated in patients with peritonitis or mechanical obstruction of the intestinal or urinary tract.

Storage Condition

Store in a cool and dry place, protected from light.

Innovators Monograph

You find simplified version here Instigmine

Instigmine contains Neostigmine see full prescribing information from innovator Instigmine Monograph, Instigmine MSDS, Instigmine FDA label

*** Taking medicines without doctor's advice can cause long-term problems.
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