네오스티그민

아세틸콜린에스테라제 억제제 / 부교감신경 흥분제

**네오스티그민**은 가역적 아세틸콜린에스테라제 억제제로, 수의학에서는 주로 **중증 근무력증**의 진단 및 관리, 그리고 비탈분극성 신경근 차단제의 효과를 길항하는 데 사용됩니다. 극성 구조를 가지고 있어 중추신경계(CNS)로의 투과성이 낮습니다. > **임상 경고:** 투여 시 생명을 위협하는 **콜린성 위기**를 유발할 수 있습니다. 심각한 무스카린성 부작용(예: 심한 서맥, 심정지, 기관지 수축)을 조절하기 위해 글리코피로늄과의 복합제를 사용하거나 즉각적인 정맥 투여를 위해 아트로핀을 준비해 두는 것이 강력히 권장됩니다.

작용 기전: Neostigmine acts as a reversible inhibitor of the enzyme **acetylcholinesterase** at the neuromuscular junction (NMJ) and autonomic synapses. Inhibition of **acetylcholinesterase** → Decreased breakdown of **acetylcholine (ACh)** → Accumulation of ACh in the synaptic cleft → Prolonged and enhanced stimulation of **nicotinic** and **muscarinic receptors** → Improved muscle contraction (in myasthenia gravis) and reversal of non-depolarizing neuromuscular blockade.

동물 종별 용량

Dogs

Diagnosis of myasthenia gravis / Antagonism of non-depolarizing neuromuscular block · 0.05 mg total dose (historical) · IV · Single dose · N/A · Historical dose; recent reports indicate this can cause cholinergic crisis. Recommended to use combined formulation with glycopyrronium. Pre-treat with atropine if using for MG diagnosis.

Cats

Diagnosis of myasthenia gravis / Antagonism of non-depolarizing neuromuscular block · 0.05 mg total dose (historical) · IV · Single dose · N/A · Extrapolated from general text. Extreme caution due to risk of feline asthma exacerbation.

용량은 면허 수의 전문가를 위한 임상 참고 자료입니다. 항상 최신 라벨과 개별 환자에 대해 확인하십시오.

투여 경로

IVIMPO

금기

Mechanical gastrointestinal obstruction
Mechanical urinary tract obstruction
Peritonitis

이상반응

Nausea and vomiting
Increased salivation (ptyalism)
Diarrhoea
Muscle fasciculations and cramps
Weakness and paralysis (with overdose)
Severe bradyarrhythmias or asystole
Miosis and nystagmus
Hypotension
Bronchoconstriction and increased bronchial secretions

약물 상호작용

Aminoglycosides · May antagonize the neuromuscular effects of neostigmine · moderate
Clindamycin · May antagonize the neuromuscular effects of neostigmine · moderate
Halogenated inhalational anaesthetics · May antagonize the neuromuscular effects of neostigmine · moderate
Quinine and related compounds · May increase clinical severity of myasthenia gravis and reduce neostigmine effectiveness · moderate
Beta-blockers · May reduce effectiveness in myasthenia gravis; concurrent use may result in severe bradycardia · major
Suxamethonium · Neostigmine inhibits its metabolism, prolonging and enhancing its clinical effect (combined use not recommended) · major
Non-depolarizing muscle relaxants · Neostigmine antagonizes their effect (therapeutic use) · major
Atropine · Antagonizes the muscarinic effects of neostigmine (used therapeutically to manage side effects) · moderate

모니터링

Heart rate and rhythm (ECG monitoring recommended during IV administration)
Respiratory rate, effort, and airway patency
Signs of cholinergic crisis (excessive salivation, urination, defecation, miosis)
Muscle strength and fasciculations

과용량

**Cholinergic Crisis** can occur with overdosage, presenting with both muscarinic and nicotinic effects (SLUDGE signs: Salivation, Lacrimation, Urination, Defecation, Gastrointestinal distress, Emesis), miosis, bradycardia, hypotension, muscle cramps, fasciculations, weakness, paralysis, bronchoconstriction, ataxia, seizures, and coma. **Management:** * **Maintenance of respiration** is the absolute priority. * Administer **Atropine** to control muscarinic signs (note: atropine does *not* antagonize nicotinic effects like muscle weakness and paralysis). * If muscle twitching is severe, control with small doses of a **competitive neuromuscular blocker**. * The cholinesterase reactivator **pralidoxime** can be used as an adjunct to atropine. * Provide intensive supportive care as required.

VetSheet 약물 레퍼런스는 면허 수의 전문가를 위한 임상 의사결정 보조 도구이며, 전문적 판단이나 제조사의 최신 라벨을 대신하지 않습니다.