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neostigmine 🐶 Veterinary Use | Indications/Contra | FAERs-F | FAERs-M | Orange Bk | BioActivity |

Stem definition	Drug id	CAS RN
acetylcholinesterase inhibitors	1897	59-99-4

Description:

Molecule	Description
Molfile Inchi Smiles Synonyms: neostigmine eustigmin eustigmine prostigmin prostigmine vagostigmine neostigmine methylsulfate neostigmine bromide	A cholinesterase inhibitor used in the treatment of myasthenia gravis and to reverse the effects of muscle relaxants such as gallamine and tubocurarine. Neostigmine, unlike PHYSOSTIGMINE, does not cross the blood-brain barrier. Molecular weight: 223.30 Formula: C12H19N2O2 CLOGP: -2.81 LIPINSKI: 0 HAC: 4 HDO: 0 TPSA: 29.54 ALOGS: -3.58 ROTB: 3 Status: OFP Legend: OFP - off patent OFM - off market ONP - on patent

Molecule

Description

Molfile Inchi Smiles

Synonyms:

neostigmine
eustigmin
eustigmine
prostigmin
prostigmine
vagostigmine
neostigmine methylsulfate
neostigmine bromide

A cholinesterase inhibitor used in the treatment of myasthenia gravis and to reverse the effects of muscle relaxants such as gallamine and tubocurarine. Neostigmine, unlike PHYSOSTIGMINE, does not cross the blood-brain barrier.

Molecular weight: 223.30
Formula: C12H19N2O2
CLOGP: -2.81
LIPINSKI: 0
HAC: 4
HDO: 0
TPSA: 29.54
ALOGS: -3.58
ROTB: 3

Status: OFP

Legend:
OFP - off patent
OFM - off market
ONP - on patent

Drug dosage:

Dose	Unit	Route
60	mg	O
2	mg	P
0.40	ml	None
40	mg	ointment

ADMET properties:

Property	Value	Reference
BDDCS (Biopharmaceutical Drug Disposition Classification System)	3	Benet LZ, Broccatelli F, Oprea TI
S (Water solubility)	100 mg/mL	Benet LZ, Broccatelli F, Oprea TI
EoM (Fraction excreted unchanged in urine)	67 %	Benet LZ, Broccatelli F, Oprea TI
MRTD (Maximum Recommended Therapeutic Daily Dose)	0.12 µM/kg/day	Contrera JF, Matthews EJ, Kruhlak NL, Benz RD
BA (Bioavailability)	2 %	Kim MT, Sedykh A, Chakravarti SK, Saiakhov RD, Zhu H
Vd (Volume of distribution)	0.74 L/kg	Lombardo F, Berellini G, Obach RS
CL (Clearance)	9.20 mL/min/kg	Lombardo F, Berellini G, Obach RS
t_half (Half-life)	1.30 hours	Lombardo F, Berellini G, Obach RS
fu (Fraction unbound in plasma)	1 %	Kawashima H, Watanabe R, Esaki T, Kuroda M, Nagao C, Natsume-Kitatani Y, Ohashi R, Komura H, Mizuguchi K

Approvals:

Date	Agency	Company	Orphan
May 31, 2013	FDA	ECLAT PHARMS LLC

FDA Adverse Event Reporting System (Female)

MedDRA adverse event term	Likelihood ratio	Likelihood ratio threshold	Patients taking drug having adverse event	Patients taking drug not having adverse event	Patients not taking drug having adverse event	Patients not taking drug not having adverse event
Serotonin syndrome	73.73	28.84	29	1899	28653	63458441
Neuromuscular block prolonged	67.16	28.84	12	1916	530	63486564
Atrioventricular dissociation	48.51	28.84	8	1920	218	63486876
Anaphylactic reaction	47.98	28.84	28	1900	66072	63421022
Apnoea	47.10	28.84	15	1913	8007	63479087
Subileus	46.01	28.84	12	1916	3167	63483927
Procedural hypertension	45.63	28.84	8	1920	316	63486778
Vascular encephalopathy	43.17	28.84	8	1920	433	63486661
Dystonia	42.74	28.84	16	1912	13803	63473291
Pulmonary oedema	39.16	28.84	23	1905	54850	63432244
Cardiac arrest	37.05	28.84	27	1901	92518	63394576
Stress cardiomyopathy	36.90	28.84	13	1915	9437	63477657
Delayed recovery from anaesthesia	32.94	28.84	7	1921	764	63486330
Myopia	32.63	28.84	8	1920	1647	63485447
Generalised tonic-clonic seizure	31.33	28.84	16	1912	29000	63458094
Ileus	31.30	28.84	13	1915	14712	63472382
Presbyopia	30.26	28.84	6	1922	465	63486629
Tachycardia	29.21	28.84	26	1902	118130	63368964

FDA Adverse Event Reporting System (Male)

MedDRA adverse event term	Likelihood ratio	Likelihood ratio threshold	Patients taking drug having adverse event	Patients taking drug not having adverse event	Patients not taking drug having adverse event	Patients not taking drug not having adverse event
Serotonin syndrome	123.94	37.63	40	1164	19893	34935834
Bradycardia	113.57	37.63	54	1150	75364	34880363
Cardiac arrest	89.96	37.63	50	1154	96109	34859618
Drug interaction	69.41	37.63	59	1145	225887	34729840
Metabolic acidosis	55.66	37.63	28	1176	43652	34912075
Pseudomonal sepsis	52.58	37.63	14	1190	3533	34952194
Appendicitis perforated	40.36	37.63	10	1194	1898	34953829
Acute pulmonary oedema	38.54	37.63	13	1191	7330	34948397

FDA Adverse Event Reporting System (Geriatric)

MedDRA adverse event term	Likelihood ratio	Likelihood ratio threshold	Patients taking drug having adverse event	Patients taking drug not having adverse event	Patients not taking drug having adverse event	Patients not taking drug not having adverse event
Serotonin syndrome	142.02	24.83	57	3143	44970	79696218
Bradycardia	114.93	24.83	70	3130	135487	79605701
Cardiac arrest	102.01	24.83	71	3129	172025	79569163
Pulmonary oedema	68.14	24.83	43	3157	88211	79652977
Neuromuscular block prolonged	67.62	24.83	14	3186	1016	79740172
Drug interaction	64.41	24.83	81	3119	415102	79326086
Apnoea	51.83	24.83	19	3181	11685	79729503
Tachycardia	50.90	24.83	48	3152	177720	79563468
Laryngospasm	48.76	24.83	14	3186	3983	79737205
Delayed recovery from anaesthesia	45.17	24.83	11	3189	1662	79739526
Procedural hypertension	43.18	24.83	8	3192	325	79740863
Atrioventricular dissociation	42.88	24.83	8	3192	338	79740850
Anaphylactic reaction	41.36	24.83	31	3169	83712	79657476
Dystonia	40.75	24.83	19	3181	21380	79719808
Vascular encephalopathy	38.18	24.83	8	3192	615	79740573
Stress cardiomyopathy	38.14	24.83	15	3185	11151	79730037
Subileus	35.87	24.83	12	3188	5642	79735546
Metabolic acidosis	35.18	24.83	28	3172	82501	79658687
Hypotension	35.09	24.83	63	3137	440254	79300934
Pseudomonal sepsis	34.83	24.83	12	3188	6162	79735026
Acute pulmonary oedema	34.63	24.83	15	3185	14215	79726973
Ileus	34.21	24.83	18	3182	26193	79714995
Cholinergic syndrome	33.75	24.83	8	3192	1079	79740109
Appendicitis perforated	33.53	24.83	10	3190	3243	79737945
Atrioventricular block second degree	32.85	24.83	12	3188	7300	79733888
Accelerated idioventricular rhythm	32.70	24.83	6	3194	231	79740957
Hyperthermia malignant	30.21	24.83	9	3191	2908	79738280
Post procedural complication	30.07	24.83	16	3184	23813	79717375
Angle closure glaucoma	30.03	24.83	9	3191	2967	79738221
Myopia	29.08	24.83	8	3192	1948	79739240
White blood cell count increased	29.01	24.83	24	3176	74609	79666579
Neuromuscular blockade	27.34	24.83	6	3194	574	79740614
Presbyopia	27.16	24.83	6	3194	592	79740596
Intestinal pseudo-obstruction	26.80	24.83	8	3192	2601	79738587
Non-cardiogenic pulmonary oedema	26.37	24.83	7	3193	1492	79739696

FDA Adverse Event Reporting System (Pediatric)

None

Pharmacologic Action:

Source	Code	Description
ATC	N07AA01	NERVOUS SYSTEM OTHER NERVOUS SYSTEM DRUGS PARASYMPATHOMIMETICS Anticholinesterases
ATC	N07AA51	NERVOUS SYSTEM OTHER NERVOUS SYSTEM DRUGS PARASYMPATHOMIMETICS Anticholinesterases
ATC	S01EB06	SENSORY ORGANS OPHTHALMOLOGICALS ANTIGLAUCOMA PREPARATIONS AND MIOTICS Parasympathomimetics
FDA MoA	N0000000177	Cholinesterase Inhibitors
MeSH PA	D018678	Cholinergic Agents
MeSH PA	D002800	Cholinesterase Inhibitors
MeSH PA	D004791	Enzyme Inhibitors
MeSH PA	D018377	Neurotransmitter Agents
MeSH PA	D010277	Parasympathomimetics
MeSH PA	D018373	Peripheral Nervous System Agents
CHEBI has role	CHEBI:38462	acetylcholinesterase inhibitors
CHEBI has role	CHEBI:74530	curare poisoning antidote
CHEBI has role	CHEBI:37733	EC 3.1.1.8 inhibitor
FDA EPC	N0000175723	Cholinesterase Inhibitor

Drug Use | Suggest Off label Use Form| |View source of the data|

Disease	Relation	SNOMED_ID	DOID
Myasthenia gravis	indication	91637004	DOID:437
Reversal of neuromuscular blockade	indication	241703000
Retention of urine	indication	267064002
Urinary tract obstruction	contraindication	7163005	DOID:5200
Peptic ulcer	contraindication	13200003	DOID:750
Increased gastric tonus	contraindication	18644006
Hyperthyroidism	contraindication	34486009	DOID:7998
Conduction disorder of the heart	contraindication	44808001
Peritonitis	contraindication	48661000
Sinus bradycardia	contraindication	49710005
Coronary occlusion	contraindication	63739005
Gastrointestinal obstruction	contraindication	126765001
Seizure disorder	contraindication	128613002
Asthma	contraindication	195967001	DOID:2841
Macrocolon	contraindication	367495003
Gastrointestinal hypomotility	contraindication	421807004
Increased Bronchial Secretions	contraindication
Colonic Necrosis	contraindication

🐶 Veterinary Drug Use

Species	Use	Relation
Cattle	Rumen atony	Indication
Cattle	Initiating peristalsis which causes evacuation of the bowel	Indication
Cattle	Emptying the urinary bladder	Indication
Cattle	Stimulating skeletal muscle contractions	Indication
Cattle	Antagonizes the effect of curare	Indication
Horses	Rumen atony	Indication
Horses	Initiating peristalsis which causes evacuation of the bowel	Indication
Horses	Emptying the urinary bladder	Indication
Horses	Stimulating skeletal muscle contractions	Indication
Horses	Antagonizes the effect of curare	Indication
Sheep	Rumen atony	Indication
Sheep	Initiating peristalsis which causes evacuation of the bowel	Indication
Sheep	Emptying the urinary bladder	Indication
Sheep	Stimulating skeletal muscle contractions	Indication
Sheep	Antagonizes the effect of curare	Indication
Swine	Rumen atony	Indication
Swine	Initiating peristalsis which causes evacuation of the bowel	Indication
Swine	Emptying the urinary bladder	Indication
Swine	Stimulating skeletal muscle contractions	Indication
Swine	Antagonizes the effect of curare	Indication

🐶 Veterinary products

Product	Applicant	Ingredients
Stiglyn 1:500	Intervet Inc.	1

Acid dissociation constants calculated using MoKa v3.0.0

None

Orange Book patent data (new drug applications)

None

Orange Book exclusivity data (new drug applications)

Formulation strength	Trade name	Applicant	Application number	Approval date	Type	Dose form	Route	Exclusivity date	Description
3MG/3ML (1MG/ML)	NEOSTIGMINE METHYLSULFATE	DR REDDYS	A216291	July 6, 2022	RX	SOLUTION	INTRAVENOUS	Jan. 21, 2023	COMPETITIVE GENERIC THERAPY

Bioactivity Summary:

Target	Class	Pharos	UniProt	Action	Type	Activity value (-log[M])	Bioact source	MoA source
Acetylcholinesterase	Enzyme	P22303	ACES_HUMAN	INHIBITOR	IC50	7.59	WOMBAT-PK	CHEMBL
Cholinesterase	Enzyme	P06276	CHLE_HUMAN		IC50	7.22	CHEMBL
Acetylcholinesterase	Enzyme		ACES_TORCA		IC50	8.34	CHEMBL
Acetylcholinesterase	Enzyme		ACES_RAT		IC50	7.46	CHEMBL
Acetylcholinesterase	Enzyme		ACES_ELEEL		Ki	6	CHEMBL
Cholinesterase	Enzyme		CHLE_HORSE		IC50	7.15	CHEMBL

External reference:

ID	Source
4019856	VUID
N0000147942	NUI
D00995	KEGG_DRUG
51-60-5	SECONDARY_CAS_RN
4017784	VANDF
4017785	VANDF
4019856	VANDF
C0027679	UMLSCUI
CHEBI:7514	CHEBI
CHEMBL54126	ChEMBL_ID
CHEMBL278020	ChEMBL_ID
DB01400	DRUGBANK_ID
CHEMBL211471	ChEMBL_ID
D009388	MESH_DESCRIPTOR_UI
4456	PUBCHEM_CID
8993	IUPHAR_LIGAND_ID
114-80-7	SECONDARY_CAS_RN
3982TWQ96G	UNII
262500	RXNORM
3968	MMSL
5165	MMSL
5166	MMSL
72417	MMSL
9863	MMSL
d00313	MMSL
001703	NDDF
001704	NDDF
001705	NDDF
373346001	SNOMEDCT_US
387294009	SNOMEDCT_US
80024007	SNOMEDCT_US
87151005	SNOMEDCT_US
401	INN_ID

Pharmaceutical products:

Product	Category	Ingredients	NDC	Form	Quantity	Route	Marketing	Label
NEOSTIGMINE METHYLSULFATE	HUMAN PRESCRIPTION DRUG LABEL	1	0404-9925	INJECTION	1 mg	INTRAVENOUS	ANDA	15 sections
NEOSTIGMINE METHYLSULFATE	HUMAN PRESCRIPTION DRUG LABEL	1	0404-9925	INJECTION	1 mg	INTRAVENOUS	ANDA	15 sections
Neostigmine Methylsulfate	HUMAN PRESCRIPTION DRUG LABEL	1	0517-1133	INJECTION	0.50 mg	INTRAVENOUS	ANDA	24 sections
Neostigmine Methylsulfate	HUMAN PRESCRIPTION DRUG LABEL	1	0517-1134	INJECTION	1 mg	INTRAVENOUS	ANDA	24 sections
NEOSTIGMINE METHYLSULFATE	HUMAN PRESCRIPTION DRUG LABEL	1	0548-9601	INJECTION	0.50 mg	INTRAVENOUS	ANDA	16 sections
NEOSTIGMINE METHYLSULFATE	HUMAN PRESCRIPTION DRUG LABEL	1	0548-9601	INJECTION	0.50 mg	INTRAVENOUS	ANDA	16 sections
NEOSTIGMINE METHYLSULFATE	HUMAN PRESCRIPTION DRUG LABEL	1	0548-9602	INJECTION	1 mg	INTRAVENOUS	ANDA	16 sections
NEOSTIGMINE METHYLSULFATE	HUMAN PRESCRIPTION DRUG LABEL	1	0548-9602	INJECTION	1 mg	INTRAVENOUS	ANDA	16 sections
Neostigmine Methylsulfate	HUMAN PRESCRIPTION DRUG LABEL	1	0641-6149	INJECTION	1 mg	INTRAVENOUS	ANDA	24 sections
Neostigmine Methylsulfate	HUMAN PRESCRIPTION DRUG LABEL	1	0641-6149	INJECTION	1 mg	INTRAVENOUS	ANDA	24 sections
Neostigmine Methylsulfate	HUMAN PRESCRIPTION DRUG LABEL	1	0641-6150	INJECTION	0.50 mg	INTRAVENOUS	ANDA	24 sections
Neostigmine Methylsulfate	HUMAN PRESCRIPTION DRUG LABEL	1	0641-6150	INJECTION	0.50 mg	INTRAVENOUS	ANDA	24 sections
Neostigmine Methylsulfate	HUMAN PRESCRIPTION DRUG LABEL	1	0641-6240	INJECTION	1 mg	INTRAVENOUS	ANDA	29 sections
Neostigmine Methylsulfate	HUMAN PRESCRIPTION DRUG LABEL	1	0641-6264	INJECTION	0.50 mg	INTRAVENOUS	ANDA	24 sections
Neostigmine Methylsulfate	HUMAN PRESCRIPTION DRUG LABEL	1	0641-6265	INJECTION	1 mg	INTRAVENOUS	ANDA	24 sections
NEOSTIGMINE METHYLSULFATE	Human Prescription Drug Label	1	14445-413	INJECTION	0.50 mg	INTRAVENOUS	ANDA	24 sections
NEOSTIGMINE METHYLSULFATE	Human Prescription Drug Label	1	14445-414	INJECTION	1 mg	INTRAVENOUS	ANDA	24 sections
Neostigmine Methylsulfate	HUMAN PRESCRIPTION DRUG LABEL	1	23155-517	INJECTION	0.50 mg	INTRAVENOUS	ANDA	23 sections
Neostigmine Methylsulfate	HUMAN PRESCRIPTION DRUG LABEL	1	23155-518	INJECTION	1 mg	INTRAVENOUS	ANDA	23 sections
Neostigmine Methylsulfate	HUMAN PRESCRIPTION DRUG LABEL	1	25021-610	INJECTION, SOLUTION	0.50 mg	INTRAVENOUS	ANDA	28 sections
Neostigmine Methylsulfate	HUMAN PRESCRIPTION DRUG LABEL	1	25021-611	INJECTION, SOLUTION	1 mg	INTRAVENOUS	ANDA	28 sections
neostigmine methylsulfate	Human Prescription Drug Label	1	31722-994	INJECTION	0.50 mg	INTRAVENOUS	ANDA	24 sections
neostigmine methylsulfate	Human Prescription Drug Label	1	31722-995	INJECTION	1 mg	INTRAVENOUS	ANDA	24 sections
NEOSTIGMINE METHYLSULFATE	HUMAN PRESCRIPTION DRUG LABEL	1	42023-188	INJECTION	0.50 mg	INTRAVENOUS	ANDA	23 sections
NEOSTIGMINE METHYLSULFATE	HUMAN PRESCRIPTION DRUG LABEL	1	42023-189	INJECTION	1 mg	INTRAVENOUS	ANDA	23 sections
PREVDUO	Human Prescription Drug Label	2	42023-269	INJECTION	1 mg	INTRAVENOUS	NDA	25 sections
Neostigmine	HUMAN PRESCRIPTION DRUG LABEL	1	43598-528	INJECTION	0.50 mg	INTRAVENOUS	ANDA	24 sections
Neostigmine	HUMAN PRESCRIPTION DRUG LABEL	1	43598-529	INJECTION	1 mg	INTRAVENOUS	ANDA	24 sections
Neostigmine Methylsulfate	HUMAN PRESCRIPTION DRUG LABEL	1	43598-945	INJECTION, SOLUTION	1 mg	INTRAVENOUS	ANDA	26 sections
NEOSTIGMINE METHYLSULFATE	HUMAN PRESCRIPTION DRUG LABEL	1	50090-4532	INJECTION	1 mg	INTRAVENOUS	ANDA	17 sections