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Brand & Generic Names


Basic Information

  • Habit forming? No
  • Prescription needed? Yes
  • Available as generic? Yes
  • Drug class: Cholinergic, antimyasthenic


  • Diagnosis and treatment of myasthenia gravis.
  • Treatment of urinary retention and abdominal distention.
  • Antidote to adverse effects of muscle relaxants used in surgery.

Dosage & Usage Information

How to take:
Tablet--Swallow with liquid or food to lessen stomach irritation.
Extended-release capsules and tablets--Swallow each dose whole with liquid; do not crush.

When to take:
As directed, usually 3 or 4 times a day.

If you forget a dose:
Take as soon as you remember up to 2 hours late. If more than 2 hours, wait for next scheduled dose (don't double this dose).

What drug does:
Inhibits the chemical activity of an enzyme (cholinesterase) so nerve impulses can cross the junction of nerves and muscles.

Time lapse before drug works:
3 hours.

Don't take with:
Any other medicine without consulting your doctor or pharmacist.


Muscle weakness or paralysis, cramps, twitching or clumsiness; severe diarrhea, nausea, vomiting, stomach cramps or pain; breathing difficulty; confusion, irritability, nervousness, restlessness, fear; unusually slow heartbeat; seizures; blurred vision; extreme fatigue.


  • Dial 911 (emergency) or O (operator) for an ambulance or medical help. Then give first aid immediately.
  • See EMERGENCY Information.

Possible Adverse Reactions or Side Effects


    In case of overdose, see Overdose section.


  • Mild diarrhea, nausea, vomiting, stomach cramps or pain.
  • Excess saliva, unusual sweating.


  • Confusion, irritability.
  • Constricted pupils, watery eyes, lung congestion, frequent urge to urinate.


    Bronchospasm, slow heartbeat, weakness.

Warnings & Precautions

Don't take if:

  • You are allergic to any cholinergic* or bromide.
  • You take mecamylamine.

Before you start, consult your doctor:

  • If you plan to become pregnant within medication period.
  • If you have bronchial asthma.
  • If you have heartbeat irregularities.
  • If you have urinary obstruction or urinary tract infection.

Over age 60:
Adverse reactions and side effects may be more frequent and severe than in younger persons.

No proven harm to unborn child. Avoid if possible. May increase contractions of the womb close to time of delivery.

No problems expected, but consult doctor.

Infants & children:
Not recommended.

Prolonged use:
Medication may lose effectiveness. Discontinuing for a few days may restore effect.

Skin & sunlight:
No problems expected.

Driving, piloting or hazardous work:
Don't drive or pilot aircraft until you learn how medicine affects you. Don't work around dangerous machinery. Don't climb ladders or work in high places. Danger increases if you drink alcohol or take medicine affecting alertness and reflexes, such as antihistamines, tranquilizers, sedatives, pain medicine, narcotics and mind-altering drugs.

Don't discontinue without doctor's advice until you complete prescribed dose, even though symptoms diminish or disappear.

No problems expected.

Possible Interaction with Other Drugs

------------------------ -----------------------
Anesthetics*, Decreased
local or general neostigmine effect.
Antiarrhythmics* Decreased neostigmine effect.
Anticholinergics* Decreased neostigmine effect. May
mask severe side effects.
Cholinergics*, Reduced intestinal tract function.
other Possible brain and nervous system
Guanadrel Decreased neostigmine effect.
Guanethridine Decreased neostigmine effect.
Mecamylamine Decreased neostigmine effect.
Nitrates* Decreased neostigmine effect.
Procainamide Decreased neostigmine effect.
Quinidine Decreased neostigmine effect.
Tiremethaphan Decreased neostigmine effect.

Possible Interaction with Other Substances

--------------- ---------------
Alcohol: No proven problems with small
Beverages: None expected.
Cocaine: Decreased neostigmine effect.
Foods: None expected.
Marijuana: No proven problems.
Tobacco: No proven problems.

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