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Indication & Dosage |
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| Oral |
| MYASTHENIA GRAVIS |
| Adult:
As bromide: 15 mg every 3-4 hr. Total daily dose is 75-300 mg in divided doses. Individualise dosing intervals to maximal response. |
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| Oral |
| MYASTHENIA GRAVIS |
| Child:
As bromide: 2 mg/kg daily, divided into doses and given every 3-4 hr. Total daily dose is 15-90 mg. |
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| Oral |
| PARALYTIC ILEUS AND POSTOPERATIVE URINARY RETENTION |
| Adult:
As bromide: 15-30 mg. |
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| Intravenous |
| NEONATAL MYASTHENIA GRAVIS |
| Child:
As bromide: 1-5 mg every 4 hr. |
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| Intravenous |
| REVERSAL OF NONDEPOLARISING NEUROMUSCULAR BLOCKADE |
| Adult:
As metilsulfate: 50-70 mcg/kg by IV inj over 60 sec. Alternatively, 0.5-2 mg up to a max of 5 mg. |
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| Intravenous |
| REVERSAL OF NONDEPOLARISING NEUROMUSCULAR BLOCKADE |
| Adult:
As metilsulfate: Children: 0.025-0.08 mg/kg/dose. Infants: 0.025-0.1 mg/kg/dose. |
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| Intramuscular |
| DIAGNOSIS OF MYASTHENIA GRAVIS |
| Adult:
As metilsulfate: 0.02 mg/kg as a single dose. Discontinue all anticholinesterase medications for at least 8 hr prior to admin. |
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| Intramuscular |
| DIAGNOSIS OF MYASTHENIA GRAVIS |
| Child:
As metilsulfate: 0.04 mg/kg as a single dose. Discontinue all anticholinesterase medications for at least 8 hr prior to admin. |
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| Parenteral |
| MYASTHENIA GRAVIS |
| Adult:
As metilsulfate: 0.5-2.5 mg IM/SC at intervals, up to a total daily dose of 5-20 mg. |
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| Parenteral |
| MYASTHENIA GRAVIS |
| Child:
As metilsulfate: 200-500 mcg IM/SC as single daily dose. |
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| Parenteral |
| PARALYTIC ILEUS AND POSTOPERATIVE URINARY RETENTION |
| Adult:
As metilsulfate: 0.5 mg IM/SC. |
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| Parenteral |
| NEONATAL MYASTHENIA GRAVIS |
| Child:
As metilsulfate: 50-250 mcg IM/SC every 4 hr. |
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| Ophthalmic |
| GLAUCOMA |
| Adult:
Instil 1-2 drops of 0.5% solution into the eyes 1-4 times daily. |
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| Precautions |
Patients with epilepsy, bronchial asthma, bradycardia, recent MI, hypotension, vagotonia, hyperthyroidism, recent intestinal or bladder surgery, renal impairment, arrhythmias, peptic ulcer. Distinguish cholinergic crisis due to overdosage from myasthenic crisis. Pregnancy and lactation. Atropine should always be available when given by inj. |
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Potentially Life-threatening
Adverse Drug Reactions |
Increased salivation and sweating, nausea and vomiting, abdominal cramps, diarrhoea, allergic reactions, rash (bromide salt), miosis, increased bronchial secretions, bradycardia, bronchospasm, weakness, muscle cramps, fasciculation, hypotension. |
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| Adverse Drug Reactions |
Anaphylaxis. |
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| Interactions |
May reduce effects of anticholinergics. May increase effects of cholinergic agonists. Increased risk of bradycardia with digoxin, diltiazem, verapamil or β-blockers without intrinsic sympathomimetic activity. Increased muscle weakness and decreased response to anticholinesterases with corticosteroids. May increase effects of depolarising neuromuscular blockers. Effects may be antagonised by drugs with neuromuscular blocking activity e.g. aminoglycosides, clindamycin, colistin, cyclopropane, halogenated inhalational anaesthetics. Effects may be reduced by quinine, chloroquine, hydroxychloroquine, quinidine, procainamide, propafenone, lithium, β-blockers. Possible additive toxicity with ophthalmic use of anticholinesterases e.g. ecothiopate. |
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