📋 Indications & Clinical Dosage
*Myasthenia gravis:*
Adult: 30-120 mg, doses to be given at suitable intervals throughout day; usual dose0.3-1.2 g daily in divided doses. Consider immunosuppressant therapy if total daily dose exceeds 360 mg, down-regulation of acetylcholine receptors possible if total daily dose exceeds 450 mg
Children: Neonate: initially 1-1.5 mg/kg, increased gradually to max 10 mg, repeated throughout the day, give 30-60 minutes before feeds; 1 month-12 yr: Initially 1-1.5 mg/kg/day, increased gradually to 7 mg/kg/day in 6 divided doses; usual total daily dose 30-360 mg; 12-18 yr: 30-120 mg, repeated throughout the day; usual total daily dose 300-600 mg. Consider immunosuppressant therapy if total daily dose exceeds 360 mg, down-regulation of acetylcholine receptors possible if total daily dose exceeds 450 mg.
*Paralytic ileus:*
Adult: 60-240 mg as required.
⛔ Contraindications
Intestinal or urinary obstruction.
⚠️ Precautions & Warnings
Arrhythmias, asthma (extreme caution), cardiac disease, renal impairment (reduce dose), vagotonia, epilepsy, Parkinsonism, bradycardia, hyperthyroidism, hypotension, peptic ulceration, recent myocardial infarction. Glycopyrronium or atropine should also be given when reversing neuromuscular blockade
🔄 Drug Interactions
Depolarising muscle relaxants, cyclopropane, halothane.
⚠️ Adverse Reactions / Side Effects
Abdominal cramps, diarrhoea, increased salivation, nausea
🤰 Pregnancy & Lactation Safety
Pregnancy Risk:
Caution advised or avoid
Lactation / Breastfeeding:
Contraindicated or avoid
📚 Official Regulatory & Clinical References
- Drug Regulatory Authority of Pakistan (DRAP): Drug Registration, S.R.O. Price Gazettes & National Essential Medicines List (NEML).
- World Health Organization (WHO): Collaborating Centre for Drug Statistics Methodology (ATC/DDD Index).
- Formulary Standards: British National Formulary (BNF) & Pakistan National Formulary (PNF) guidelines.