About neostigmine

Myasthenia gravis is a condition where your muscles become easily tired and weak. Your muscles are not being stimulated by your nerves properly, and so are not contracting well. Myasthenia gravis is an autoimmune disease. This means that the fault is due to a problem with your immune system, which is mistakenly attacking itself.

Your brain normally sends messages down your nerves to the muscles it wants to contract. Your nerve endings then release a chemical called acetylcholine. Acetylcholine quickly attaches to small areas on your muscles called receptors, and this triggers your muscles to contract. In most people with myasthenia gravis, the immune system blocks or destroys acetylcholine receptors, which results in your muscles being less able to contract.

Neostigmine works by delaying the breakdown of acetylcholine when it is released from nerve endings. This means that there is more acetylcholine available for the muscle receptors, which improves the strength of your muscles.

Before taking neostigmine

Some medicines are not suitable for people with certain conditions, and sometimes a medicine may only be used if extra care is taken. For these reasons, before you start taking neostigmine it is important that your doctor or pharmacist knows:

• If you are pregnant, trying for a baby or breast-feeding.
• If you have asthma.
• If you have epilepsy, Parkinson's disease, an overactive thyroid, or low blood pressure.
• If you have heart problems, such as a slow heart rate, or if you have recently had a heart attack.
• If you have a stomach ulcer.
• If you have kidney problems.
• If you have been told you have a blockage in your intestines or urinary system.
• If you are taking or using any other medicines. This includes any medicines you are taking which are available to buy without a prescription, such as herbal and complementary medicines.
• If you have ever had an allergic reaction to any medicine.

How to take neostigmine

• Before you start this treatment, read the manufacturer's printed information leaflet from inside your pack. The leaflet will give you more information about neostigmine, and a full list of possible side-effects from taking it.
• Take neostigmine tablets exactly as your doctor has told you. Your dose will also be on the label of the pack. It is usual to take one or two tablets several times a day, as the effect of the tablets lasts for about four hours. Take the tablets at suitable intervals so that your muscles are strongest when you need to be the most active.
• It is likely that you will be prescribed other medicines to take alongside neostigmine. You may be prescribed an immunosuppressant or corticosteroid medicine to help control your symptoms. You may also be prescribed tablets to reduce some unwanted effects from taking neostigmine. This is because neostigmine can produce side-effects such as abdominal cramp and diarrhoea. If you are unsure when or how to take all of these medicines, ask your doctor or pharmacist to explain it to you again.

Getting the most from your treatment

• Try to keep your regular appointments with your doctor. This is so your doctor can check on your progress.
• If you are having an operation or dental treatment, tell the person carrying out the treatment that you are taking neostigmine. This is important because neostigmine interferes with medicines used during an anaesthetic.
• If you buy any medicines, check with a pharmacist that they are suitable to take with your other medicines.

Can neostigmine cause problems?

Along with their useful effects, most medicines can cause unwanted side-effects although not everyone experiences them. These usually improve as your body adjusts to the new medicine, but speak with your doctor or pharmacist if any of the following side-effects continue or become troublesome.

How to store neostigmine

• Keep all medicines out of the reach and sight of children.
• Store in a cool, dry place, away from direct heat and light.

Important information about all medicines