Neuro-Muscular Drugs

9 Drugs classified under this therapeutic system

Anticholinergic agent. Atropine Sulphate 1 mg/ml.
AMP. (sol. for IM, IV inj.): 5×1ml. Pre-anesthet. med.: Adults: 0.3-0.6 mg by IV inj. immed. before the anesthes. induct. or by IM inj. 30-60 min. before the induc.
Child.: 0.02 mg/kg (max. dose 0.6 mg).
Tmt. of sinus bradycard.: 0.3 and 1.0 mg IV.
Antidote in poison. by organophosphorus:
Adult.: 2 mg (IM or IV, taking into account the sever. of the poison.) every 5-10 min., until the skin becomes red and dry, the pupils dilate and tachycard. appears.
Child.: The 0.02 mg/kg.
Preanesthetic medication to decrease excessive salivation and secretions of the respiratory tract. Treatment of sinus bradycardia, particularly if complicated by hypotension.
Antidote in poisoning by organophosphorus.
C/I: Hypersens. Clos. ang. glauc., esophag. reflux, pyloric stenosis, GI obstruct., ulcerat. colit., prostat. hypertrophy, paralytic ileus, intest. atony.

Monoclonal Antibody, Neonatal Fc Receptor Antagonist (FcRn). nipocalimab 185 mg.
VIAL.Conc. for sol. for inf. 1 x 1.62 /6.5 ml.
Initial dosage is 30 mg/kg admin. once via IV. After 2 weeks, admin a maint. dosage of 15 mg/kg. Continue maint. dosage every two weeks thereafter.
Tmt. of gralized myasthenia gravis (gMG) in adult and ped. pts  >12 years who are anti-acetylcholine recept. (AChR) or antimuscle- specific tyrosine kinase (MuSK) antibody pos.
C/I: Hypersens. Reactions have incl. anaphylaxis and angioedema.

Acetylcholinesterase Inhibitor. Pyridostigmine (Bromide) 60 mg.
DRAGEES: 20. See lit.
Myasthen. gravis.
C/I: Hypersens., mechan. obstruct. GI/
urinary tract., inflamm. peritoneum,
disords. accomp. incr. tonus bronch.
muscles (spastic bronchit./bronch.
asthma), lact.

Anticholinesterase. Neostigmine Methylsulphate 2.5 mg/ml.
AMPOUL.: 10×1ml.  Should be given very slowly by the  IV route. A syr. of Atropine Sulphate should always be available to counteract severe cholinergic react. should they occur.
Myasthen. Gr..: 1 – 2.5 mg by IM or SC inj. at interv. throughout the day, when max. strength is needed. The usual durat.  of act. of a dose is 2- 4 hrs. The total dly. dose is usually 5 – 20 mg by inject. but higher doses may be needed by some pts.
Neonatal Myasthen. Gr. may be treated with 0.1 mg Neostigmine intramuscul. initial. Thereafter, the dose must be titrated individ. But is usually 0.05 – 0.25 mg IM or 0.03 mg/kg IM, every 2 –4 hrs. Because of the self-limiting nature of the dis. in neonates, the dly. dosage should be reduced until the drug can be withdrawn.
Older Child.: (Under 12 yrs. of age) May be given 0.2 – 0.5 mg by inj. as required. Dosage require. should be adjusted accord.  to the response of the pt.
Antagon.to Non-depolariz.  Neuromusc. Blockade: Reversal of Neuromusc. blockade with Neostigmine should not be attempted unless there is spontan. recovery from paralysis.
Adult. & Child.: A single dose of Neostigmine 0.05 – 0.07 mg/kg bdy.-wt. and Atropine 0.02 – 0.03 mg/kg bdy. wt., by slow IV inj. over one min. is usually adequate for complete reversal of Non-depolariz. Muscle Relax.  within 5 – 15 min. The max. recomm. dose of Neostigmine in adult. is 5 mg and in child. 2.5 mg.
Atropine & Neostigmine may be given simultan., but in pts with Bradycardia, the pulse rate should be incr. to 80 per min. with Atropine before admin. Neostigmine.
Paralytic Ileus: Adult.: 0.5 – 2.5 mg Neostigmine Methylsulphate by SC or IM injection.
Child.: 0.125 – 1 mg by inj. Doses may be varied accord. to the individ. needs of the pt.
Myasthen. Grav., antagon. to non- epolarizing neuromusc. blockade, Paralytic Ileus.
C/I: Hypersens. Pts. with mechan. obstruct. of GI or urin. tracts, peritonitis or doubtful bowel viability. Concom. use  with depolaris. muscle relaxants such as suxamethonium as neuromuscul. blockade may be potentiated.

Acetylcholinesterase Inhibitor. Pyridostigmine (as Bromide) 30 mg, 60 mg.
TABS: 21X 30 mg, 30 X 60 mg. See lit.
Myasthen. gravis.