Details of Drug

Drug General Information (ID: D1122)
Drug Name	Neostigmine
Drug Type	Small molecule
Drug Synonymous	Eustigmin; Eustigmine; Intrastigmina; Juvastigmin; Neostigmin; Neostigminum; Prostigmin; Prostigmine; Prozerin; Sulfonatooxymethane; Synstigmin; Syntostigmine; Vagostigmin; Vagostigmine; Neostigmine [BAN]; Neostigmine omega; M-Trimethylammoniumphenyldimethylcarbamate; Neostigmine (BAN); Prostigmin (TN); Vagostigmin (TN); [3-(dimethylcarbamoyloxy)phenyl]-trimethylazanium; [3-(dimethylcarbamoyloxy)phenyl]-trimethyl-azanium; [3-(dimethylcarbamoyloxy)phenyl]-trimethyl-azanium bromide; Ammonium, (m-hydroxyphenyl)trimethyl-, dimethylcarbamate (ester); Benzenaminium, 3-(((dimethylamino)carbonyl)oxy)-N,N,N-trimethyl-(9CI); (m-Hydroxyphenyl)trimethylammonium dimethylcarbamate; (m-Hydroxyphenyl)trimethylammonium dimethylcarbamate (ester); 3-Trimethylammoniumphenyl N,N-dimethylcarbamate; 3-[(dimethylcarbamoyl)oxy]-N,N,N-trimethylanilinium; 3-{[(dimethylamino)carbonyl]oxy}-N,N,N-trimethylanilinium Click to Show/Hide
Disease Class	8C6Y: Myasthenia gravis
Therapeutic Class	Parasympathomimetics
Structure
Structure	3D Structure		2D Structure
Formula	C12H19N2O2+
InChI	1S/C12H19N2O2/c1-13(2)12(15)16-11-8-6-7-10(9-11)14(3,4)5/h6-9H,1-5H3/q+1
InChIKey	ALWKGYPQUAPLQC-UHFFFAOYSA-N
Canonical SMILES	CN(C)C(=O)OC1=CC=CC(=C1)[N+](C)(C)C
External Link
	Pubchem ID	4456
	CAS Number	59-99-4
	CHEBI ID	7514
	TTD ID	D08USJ
	VARIDT ID	DR01375

Drug-Drug Interaction Network
Sunburst Graph		Legend Information AM006 Pharmacodynamic additive effects AM007 Pharmacodynamic antagonistic effects BM037 Additive cholinergic effects BM045 Additive neuromuscular blocking effects BM049 Increased risk of atrioventricular block BM051 Increased risk of bradycardia BM069 Increased risk of lowers seizure threshold BM081 Increased risk of ventricular arrhythmias BM091 Antagonize the effect of cholinergic agents
Relation Graph

Full list of drugs interacting with Neostigmine
Pharmacodynamic additive effects
	Additive cholinergic effects					Drug Num: 10
Drug ID		Drug Name	Formula	Pubchem ID	Severity Level		Interaction Detail	REF
D0175		Bethanechol	C7H17N2O2+	2370	Moderate		Inter Info	[47], [48], [49]
D0516		Donepezil	C24H29NO3	3152	Moderate		Inter Info	[47], [48], [49]
D0546		Echothiophate (ophthalmic)	C9H23NO3PS+	10548	Moderate		Inter Info	[50]
D0552		Edrophonium	C10H16NO+	3202	Moderate		Inter Info	[47], [48], [49]
D0707		Galantamine	C17H21NO3	9651	Moderate		Inter Info	[47], [48], [49]
D0054		Amifampridine	C5H7N3	5918	Moderate		Inter Info	[64], [65]
D1285		Physostigmine	C15H21N3O2	5983	Moderate		Inter Info	[47], [48], [49]
D1365		Pyridostigmine	C9H13N2O2+	4991	Moderate		Inter Info	[47], [48], [49]
D1418		Rivastigmine	C14H22N2O2	77991	Moderate		Inter Info	[47], [48], [49]
D1525		Tacrine	C13H14N2	1935	Moderate		Inter Info	[47], [48], [49]
	Additive neuromuscular blocking effects					Drug Num: 11
Drug ID		Drug Name	Formula	Pubchem ID	Severity Level		Interaction Detail	REF
D0056		Amikacin	C22H43N5O13	37768	Moderate		Inter Info	[25], [21], [26], [27], [28], [29], [30], [31], [32], [33], [34], [35], [36], [37], [38], [39], [40], [41], [42]
D0057		Amikacin (liposome)	C22H43N5O13	37768	Moderate		Inter Info	[21], [35], [37]
D0718		Gentamicin	C21H43N5O7	3467	Moderate		Inter Info	[25], [21], [26], [27], [28], [29], [30], [31], [32], [33], [34], [35], [36], [37], [38], [39], [40], [41], [42]
D0876		Kanamycin	C18H36N4O11	6032	Moderate		Inter Info	[25], [21], [26], [27], [28], [29], [30], [31], [32], [33], [34], [35], [36], [37], [38], [39], [40], [41], [42]
D1120		Neomycin	C23H46N6O13	8378	Moderate		Inter Info	[25], [21], [26], [27], [28], [29], [30], [31], [32], [33], [34], [35], [36], [37], [38], [39], [40], [41], [42]
D1228		Paromomycin	C23H45N5O14	165580	Moderate		Inter Info	[25], [21], [26], [27], [28], [29], [30], [31], [32], [33], [34], [35], [36], [37], [38], [39], [40], [41], [42]
D1304		Plazomicin	C25H48N6O10	42613186	Moderate		Inter Info	[25], [21], [26], [27], [28], [29], [30], [31], [32], [33], [34], [35], [36], [37], [38], [39], [40], [41], [42]
D1126		Netilmicin	C21H41N5O7	441306	Moderate		Inter Info	[25], [21], [26], [27], [28], [29], [30], [31], [32], [33], [34], [35], [36], [37], [38], [39], [40], [41], [42]
D1507		Streptomycin	C21H39N7O12	19649	Moderate		Inter Info	[25], [21], [26], [27], [28], [29], [30], [31], [32], [33], [34], [35], [36], [37], [38], [39], [40], [41], [42]
D1510		Succinylcholine	C14H30N2O4+2	5314	Moderate		Inter Info	[76], [77], [47], [49], [78]
D1597		Tobramycin	C18H37N5O9	36294	Moderate		Inter Info	[25], [21], [26], [27], [28], [29], [30], [31], [32], [33], [34], [35], [36], [37], [38], [39], [40], [41], [42]
	Increased risk of bradycardia					Drug Num: 8
Drug ID		Drug Name	Formula	Pubchem ID	Severity Level		Interaction Detail	REF
D1474		Siponimod	C29H35F3N2O3	44599207	Major		Inter Info	[21], [22]
D0031		Alectinib	C30H34N4O2	49806720	Moderate		Inter Info	[62], [63]
D0204		Brigatinib	C29H39ClN7O2P	68165256	Moderate		Inter Info	[66]
D0393		Crizotinib	C21H22Cl2FN5O	11626560	Moderate		Inter Info	[26], [67], [68]
D0661		Fingolimod	C19H33NO2	107970	Moderate		Inter Info	[69], [70]
D0868		Ivabradine	C27H36N2O5	132999	Moderate		Inter Info	[21], [71]
D0897		Lasmiditan	C19H18F3N3O2	11610526	Moderate		Inter Info	[72]
D1211		Ozanimod	C23H24N4O3	52938427	Moderate		Inter Info	[73]
	Increased risk of lowers seizure threshold					Drug Num: 10
Drug ID		Drug Name	Formula	Pubchem ID	Severity Level		Interaction Detail	REF
D0220		Bupropion	C13H18ClNO	444	Major		Inter Info	[1], [2], [3], [4], [5], [6], [7], [8], [9], [10], [11], [12], [13], [14], [15]
D0833		Iohexol	C19H26I3N3O9	3730	Major		Inter Info	[16], [17], [18], [19], [20]
D0834		Iopamidol	C17H22I3N3O8	65492	Major		Inter Info	[16], [17], [18], [19], [20]
D1616		Tramadol	C16H25NO2	33741	Major		Inter Info	[23], [14], [13], [24]
D0678		Fluphenazine	C22H26F3N3OS	3372	Moderate		Inter Info	[21], [26]
D0722		Ginkgo biloba	NA	NA	Moderate		Inter Info	[51], [52], [53], [54], [55], [56], [57], [58]
D0932		Lindane	C6H6Cl6	727	Moderate		Inter Info	[59], [60], [61]
D1287		Picosulfuric acid	C18H15NO8S2	5243	Moderate		Inter Info	[74], [75], [26]
D1308		Polyethylene glycol (3350 with electrolytes)	C2H6O2	174	Moderate		Inter Info	[74], [75], [26]
D1488		Sodium sulfate	Na2O4S	24436	Moderate		Inter Info	[74], [75], [26]
	Increased risk of ventricular arrhythmias					Drug Num: 1
Drug ID		Drug Name	Formula	Pubchem ID	Severity Level		Interaction Detail	REF
D1569		Thalidomide	C13H10N2O4	5426	Moderate		Inter Info	[21], [26], [79]
Pharmacodynamic antagonistic effects
	Antagonize the effect of cholinergic agents					Drug Num: 38
Drug ID		Drug Name	Formula	Pubchem ID	Severity Level		Interaction Detail	REF
D0123		Atropine	C17H23NO3	174174	Moderate		Inter Info	[43]
D0160		Benzatropine	C21H25NO	1201549	Moderate		Inter Info	[43]
D0172		Betamethasone	C22H29FO5	9782	Moderate		Inter Info	[44], [45], [46]
D0183		Biperiden	C21H29NO	2381	Moderate		Inter Info	[43]
D0215		Budesonide	C25H34O6	5281004	Moderate		Inter Info	[44], [45], [46]
D0353		Clidinium	C22H26NO3+	2784	Moderate		Inter Info	[43]
D0370		Clozapine	C18H19ClN4	135398737	Moderate		Inter Info	[43]
D0392		Corticotropin	C207H308N56O58S	16132265	Moderate		Inter Info	[44], [45], [46]
D0424		Darifenacin	C28H30N2O2	444031	Moderate		Inter Info	[43]
D0453		Dexamethasone	C22H29FO5	5743	Moderate		Inter Info	[44], [45], [46]
D0482		Dicyclomine	C19H35NO2	3042	Moderate		Inter Info	[43]
D0508		Disopyramide	C21H29N3O	3114	Moderate		Inter Info	[43]
D0662		Flavoxate	C24H25NO4	3354	Moderate		Inter Info	[43]
D0671		Fludrocortisone	C21H29FO5	31378	Moderate		Inter Info	[44], [45], [46]
D0733		Glycopyrronium	C19H28NO3+	3494	Moderate		Inter Info	[43]
D0773		Hydrocortisone	C21H30O5	5754	Moderate		Inter Info	[44], [45], [46]
D0782		Hyoscyamine	C17H23NO3	154417	Moderate		Inter Info	[43]
D1041		Methylprednisolone	C22H30O5	6741	Moderate		Inter Info	[44], [45], [46]
D0154		Belladonna	C34H42N2O4	265028	Moderate		Inter Info	[43]
D0436		Deflazacort	C25H31NO6	189821	Moderate		Inter Info	[44], [45], [46]
D0759		Homatropine	C16H21NO3	5282593	Moderate		Inter Info	[43]
D1000		Mepenzolate	C21H26NO3+	4057	Moderate		Inter Info	[43]
D1031		Methscopolamine	C18H24NO4+	71183	Moderate		Inter Info	[43]
D1491		Solifenacin	C23H26N2O2	154059	Moderate		Inter Info	[43]
D1202		Oxybutynin	C22H31NO3	4634	Moderate		Inter Info	[43]
D1332		Prednisolone	C21H28O5	5755	Moderate		Inter Info	[44], [45], [46]
D1334		Prednisone	C21H26O5	5865	Moderate		Inter Info	[44], [45], [46]
D1343		Procainamide	C13H21N3O	4913	Moderate		Inter Info	[43]
D1347		Procyclidine	C19H29NO	4919	Moderate		Inter Info	[43]
D1354		Propantheline	C23H30NO3+	4934	Moderate		Inter Info	[43]
D1371		Quinidine	C20H24N2O2	441074	Moderate		Inter Info	[43]
D1450		Scopolamine	C17H21NO4	3000322	Moderate		Inter Info	[43]
D1563		Tetracosactide	C136H210N40O31S	16133802	Moderate		Inter Info	[44], [45], [46]
D1607		Tolterodine	C22H31NO	443879	Moderate		Inter Info	[43]
D1628		Triamcinolone	C21H27FO6	31307	Moderate		Inter Info	[44], [45], [46]
D1630		Triamcinolone (ophthalmic)	C21H27FO6	31307	Moderate		Inter Info	[44], [45], [46]
D1641		Trihexyphenidyl	C20H31NO	5572	Moderate		Inter Info	[43]
D1656		Trospium	C25H30NO3+	5284632	Moderate		Inter Info	[43]

References
1	Product Information. Wellbutrin XL (buPROPion). GlaxoSmithKline, Philadelphia, PA.
2	Sheehan DV, Welch JB, Fishman SM "A case of bupropion-induced seizure." J Nerv Ment Dis 174 (1986): 496-8. [PMID: 3090199]
3	Canadian Pharmacists Association.
4	Product Information. Wellbutrin (bupropion). Glaxo Wellcome, Research Triangle Park, NC.
5	Gittelman DK, Kirby MG "A seizure following bupropion overdose." J Clin Psychiatry 54 (1993): 162. [PMID: 8486598]
6	Product Information. Wellbutrin SR (bupropion). Glaxo Wellcome, Research Triangle Park, NC.
7	James WA, Lippmann S "Bupropion: overview and prescribing guidelines in depression." South Med J 84 (1991): 222-4. [PMID: 1899294]
8	Masco HL, Kiev A, Holloman LC, Batey SR, Johnston JA, Lineberry CG "Safety and efficacy of bupropion and nortriptyline in outpatients with depression." Curr Ther Res Clin Exp 55 (1994): 851-63.
9	Dufresne RL, Weber SS, Becker RE "Bupropion hydrochloride." Drug Intell Clin Pharm 18 (1984): 957-64. [PMID: 6439541]
10	Product Information. Zyban (bupropion). Glaxo Wellcome, Research Triangle Park, NC.
11	Storrow AB "Bupropion overdose and seizure." Am J Emerg Med 12 (1994): 183-4. [PMID: 8161393]
12	Johnston JA, Lineberry CG, Ascher JA, et al. "A 102-center prospective study of seizure in association with bupropion." J Clin Psychiatry 52 (1991): 450-6. [PMID: 1744061]
13	Rosenstein DL, Nelson JC, Jacobs SC "Seizures associated with antidepressants: a review." J Clin Psychiatry 54 (1993): 289-99. [PMID: 8253696]
14	Pisani F, Spina E, Oteri G "Antidepressant drugs and seizure susceptibility: from in vitro data to clinical practice." Epilepsia 40(Suppl 10) (1999): S48-56. [PMID: 10609604]
15	Product Information. Aplenzin (buPROPion). sanofi-aventis , Bridgewater, NJ.
16	Product Information. Isovue-M-200 (iopamidol). Bracco Diagnostics Inc, Princeton, NJ.
17	Product Information. Amipaque (metrizamide) Nycomed Inc, Princeton, NJ.
18	Hindmarsh T, Grepe A, Widen L "Metrizamide-phenothiazine interaction: report of a case with seizures following myelography." Acta Radiol Diagn (Stockh) 16 (1975): 129-35. [PMID: 810000]
19	Product Information. Omnipaque 180 (iohexol). Amersham Health, Princeton, NJ.
20	Product Information. Osmovist 240 (iotrolan). Berlex Canada Inc, Lachine, QC.
21	Cerner Multum, Inc. "Australian Product Information.".
22	Product Information. Mayzent (siponimod). Novartis Pharmaceuticals, East Hanover, NJ.
23	Product Information. Ultram (tramadol). McNeil Pharmaceutical, Raritan, NJ.
24	Gardiner JS, Blough D, Drinkard CR, et al. "Tramadol and seizures: a surveillance study in a managed care population." Pharmacotherapy 20 (2000): 1423-31. [PMID: 11130214]
25	Burkett L, Bikhazi GB, Thomas KC Jr, Rosenthal DA, Wirta MG, Foldes FF "Mutual potentiation of the neuromuscular effects of antibiotics and relaxants." Anesth Analg 58 (1979): 107-15. [PMID: 571233]
26	Cerner Multum, Inc. "UK Summary of Product Characteristics.".
27	Chapple DJ, Clark JL, Hughes R "Interaction between atracurium and drugs used in anaesthesia." Br J Anaesth 55 Suppl (1983): s17-22. [PMID: 6688011]
28	Dupuis JY, Martin R, Tetrault JP "Atracurium and vecuronium interaction with gentamicin and tobramycin." Can J Anaesth 36 (1989): 407-11. [PMID: 2569365]
29	Geha DG, Blitt CD, Moon BJ "Prolonged neuromuscular blockade with pancuronium in the presence of acute renal failure: a case report." Anesth Analg 55 (1976): 343-5. [PMID: 945014]
30	Giala M, Sareyiannis C, Cortsaris N, Paradelis A, Lappas DG "Possible interaction of pancuronium and tubocurarine with oral neomycin." Anaesthesia 37 (1982): 776. [PMID: 7103026]
31	Giala MM, Paradelis AG "Two cases of prolonged respiratory depression due to interaction of pancuronium with colistin and streptomycin." J Antimicrob Chemother 5 (1979): 234-5. [PMID: 429254]
32	Hasfurther DL, Bailey PL "Failure of neuromuscular blockade reversal after rocuronium in a patient who received oral neomycin." Can J Anaesth 43 (1996): 617-20. [PMID: 8773869]
33	Jedeikin R, Dolgunski E, Kaplan R, Hoffman S "Prolongation of neuromuscular blocking effect of vecuronium by antibiotics." Anaesthesia 42 (1987): 858-60. [PMID: 2889390]
34	Kronenfeld MA, Thomas SJ, Turndorf H "Recurrence of neuromuscular blockade after reversal of vecuronium in a patient receiving polymyxin/amikacin sternal irrigation." Anesthesiology 65 (1986): 93-4. [PMID: 2873764]
35	Levanen J, Nordman R "Complete respiratory paralysis caused by a large dose of streptomycin and its treatment with calcium chloride." Ann Clin Res 7 (1975): 47-9. [PMID: 1155911]
36	Lippmann M, Yang E, Au E, Lee C "Neuromuscular blocking effects of tobramycin, gentamicin, and cefazolin." Anesth Analg 61 (1982): 767-70. [PMID: 7201757]
37	Pittinger CB, Eryasa Y, Adamson R "Antibiotic-induced paralysis." Anesth Analg 49 (1970): 487-501. [PMID: 4102601]
38	Product Information. Arikayce (amikacin liposome). Insmed Incorporated, Bridgewater, NJ.
39	Product Information. Humatin (paromomycin). Parke-Davis, Morris Plains, NJ.
40	Regan AG, Perumbetti PP "Pancuronium and gentamicin interaction in patients with renal failure." Anesth Analg 59 (1980): 393. [PMID: 6989291]
41	Vanacker BF, Van de Walle J "The neuromuscular blocking action of vecuronium in normal patients and in patients with no renal function and interaction vecuronium- tobramycin in renal transplant patients." Acta Anaesthesiol Belg 37 (1986): 95-9. [PMID: 2875595]
42	Warner WA, Sanders E "Neuromuscular blockade associated with gentamicin therapy." JAMA 215 (1971): 1153-4. [PMID: 4250687]
43	Product Information. Mestinon (pyridostigmine). ICN Pharmaceuticals Inc, Cost Mesa, CA.
44	Brunner NG, Namba T, Grob D "Corticosteroids in management of severe, generalized myasthenia gravis." Neurology 22 (1972): 603-10
45	Namba T "Corticotropin therapy in patients with myasthenia gravis." Arch Neurol 26 (1972): 144-50
46	Patten BM, Oliver KL, Engel WK "Adverse interaction between steroid hormones and anticholinesterase drugs." Neurology 24 (1974): 442-9
47	Product Information. Aricept (donepezil). Pfizer US Pharmaceuticals, New York, NY.
48	Product Information. Cognex (tacrine). Parke-Davis, Morris Plains, NJ.
49	Product Information. Reminyl (galantamine) Janssen Pharmaceuticals, Titusville, NJ.
50	Product Information. Phospholine Iodide (echothiophate iodide ophthalmic). Wyeth Laboratories, Philadelphia, PA.
51	Kajiyama Y, Fujii K, Takeuchi H, Manabe Y "Ginkgo seed poisoning." Pediatrics 109 (2002): 325-7. [PMID: 11826216]
52	Granger AS "Ginkgo biloba precipitating epileptic seizures." Age Ageing 30 (2001): 523-5. [PMID: 11742783]
53	Miller LG "Herbal medicinals: selected clinical considerations focusing on known or potential drug-herb interactions." Arch Intern Med 158 (1998): 2200-11. [PMID: 9818800]
54	Spinella M "Herbal medicines and epilepsy: the potential for benefit and adverse effects." Epilepsy Behav 2 (2001): 524-32. [PMID: 12609386]
55	Gregory PJ "Seizure associated with Ginkgo biloba?." Ann Intern Med 134 (2001): 344. [PMID: 11182853]
56	Harms SL, Garrard J, Schwinghammer P, Eberly LE, Chang Y, Leppik IE "Ginkgo biloba use in nursing home elderly with epilepsy or seizure disorder." Epilepsia 47 (2006): 323-9. [PMID: 16499756]
57	Miwa H, Iijima M, Tanaka S, Mizuno Y "Generalized convulsions after consuming a large amount of Gingko nuts." Epilepsia 42 (2001): 280-1. [PMID: 11240603]
58	Kupiec T, Raj V "Fatal seizures due to potential herb-drug interactions with Ginkgo biloba." J Anal Toxicol 29 (2005): 755-8. [PMID: 16419414]
59	Matsuoka LY "Convulsions following application of gamma benzene hexachloride." J Am Acad Dermatol 5 (1981): 98-9. [PMID: 6168673]
60	Cox R, Krupnick J, Bush N, Houpt A "Seizures caused by concomitant use of lindane and dextroamphetamine in a child with attention deficit hyperactivity disorder." J Miss State Med Assoc 41 (2000): 690-2. [PMID: 10974795]
61	Product Information. Kwell (lindane). Reed and Carnrick, Jersey City, NJ.
62	Product Information. Kaletra (lopinavir-ritonavir) Abbott Pharmaceutical, Abbott Park, IL.
63	Product Information. Alecensa (alectinib). Genentech, South San Francisco, CA.
64	EMEA. European Medicines Agency "EPARs. European Union Public Assessment Reports.".
65	Product Information. Firdapse (amifampridine). Catalyst Pharmaceuticals, Inc., Coral Gables, FL.
66	Product Information. Alunbrig (brigatinib). Ariad Pharmaceuticals Inc, Cambridge, MA.
67	Product Information. Xalkori (crizotinib). Pfizer U.S. Pharmaceuticals Group, New York, NY.
68	Canadian Pharmacists Association "e-CPS."
69	Product Information. Gilenya (fingolimod). Novartis Pharmaceuticals, East Hanover, NJ.
70	FDA. U.S. Food and Drug Administration "FDA Drug Safety Communication: Revised recommendations for cardiovascular monitoring and use of multiple sclerosis drug Gilenya (fingolimod).".
71	Product Information. Corlanor (ivabradine). Amgen USA, Thousand Oaks, CA.
72	Product Information. Reyvow (lasmiditan). Lilly, Eli and Company, Indianapolis, IN.
73	Product Information. Zeposia (ozanimod). Celgene Corporation, Summit, NJ.
74	Product Information. Suprep Bowel Prep Kit (magnesium/potassium/sodium sulfates). Braintree Laboratories, Braintree, MA.
75	Salik JM, Kurtin P "Severe hyponatremia after colonoscopy preparation in a patient with the acquired immune deficiency syndrome." Am J Gastroenterol 80 (1985): 177-9. [PMID: 2983533]
76	Freeman SE, Dawson RM "Tacrine: a pharmacological review." Prog Neurobiol 36 (1991): 257-77. [PMID: 1714613]
77	Heath ML "Donepezil and succinylcholine." Anaesthesia 58 (2003): 202. [PMID: 12562439]
78	Raucy J L, Allen S W "Recent advances in P450 research." Pharmacogenomics J 1 (2001): 178-86. [PMID: 11908754]
79	Product Information. Thalomid (thalidomide). Celgene Corporation, Warren, NJ.

Details of Drug

Details of Drug

Cite MecDDI

About MecDDI

Correspondence