1 Duke University Hospital, Durham, NC, USA.
2 WakeMed Health & Hospitals, Raleigh, NC, USA.
Ann Pharmacother. 2018 Jun;52(6):505-512. doi: 10.1177/1060028018754302. Epub 2018 Jan 23.
Neostigmine is traditionally administered intravenously for treatment of acute colonic pseudo-obstruction (ACPO), though use is associated with administration constraints and adverse effects.
To evaluate whether an alternative route of administration for neostigmine via subcutaneous (SQ) delivery is safe and effective in a broad cohort of medical and surgical patients.
This multicenter, retrospective observational study included adult patients administered SQ neostigmine for ileus, ACPO, or refractory constipation. Efficacy indicators were time to first bowel movement (BM) following initiation of the medication, total SQ neostigmine dose administered to produce a BM, and administration of a rescue intervention to produce a BM. Safety events evaluated were cardiac arrest, bradycardia, bronchospasm requiring intervention, nausea requiring intervention, or severe salivation, lacrimation, or diarrhea.
A total of 182 patients were eligible for inclusion. The most commonly utilized dosing strategy of neostigmine was 0.25 mg SQ 4 times daily. The median time to first BM following initiation of SQ neostigmine was 29.19 hours (interquartile range = 12.18-56.84) with a median dose administered before first BM of 1.25 mg. Three patients (1.65%) experienced an adverse drug event leading to drug discontinuation, with 2 developing bradycardia that resolved with drug discontinuation alone.
SQ neostigmine may be reasonable for management of ileus, ACPO, or refractory constipation, though use should be avoided in patients with new-onset heart block, a history of second-degree heart block, or following bowel resection with primary anastomosis. Despite the low incidence of adverse drug events observed, monitoring for bradycardia with telemetry may be considered.
传统上，新斯的明通过静脉注射用于治疗急性结肠假性梗阻（ACPO），但使用新斯的明与给药限制和不良反应有关。
评估在广泛的内科和外科患者群体中，通过皮下（SQ）途径给予新斯的明是否安全有效。
这项多中心、回顾性观察性研究纳入了接受 SQ 新斯的明治疗肠麻痹、ACPO 或难治性便秘的成年患者。疗效指标为开始使用药物后首次排便的时间（BM）、产生 BM 所需的 SQ 新斯的明总剂量以及产生 BM 所需的抢救干预措施。评估的安全性事件包括心脏骤停、心动过缓、需要干预的支气管痉挛、需要干预的恶心或严重流涎、流泪或腹泻。
共有 182 名患者符合纳入标准。新斯的明最常用的给药策略是每天 SQ 0.25mg，4 次。开始 SQ 新斯的明后首次 BM 的中位时间为 29.19 小时（四分位距=12.18-56.84），首次 BM 前中位剂量为 1.25mg。3 名患者（1.65%）发生导致药物停用的药物不良事件，其中 2 名患者出现心动过缓，仅停用药物即可缓解。
SQ 新斯的明可能可用于治疗肠麻痹、ACPO 或难治性便秘，但应避免在新发心脏传导阻滞、二度心脏传导阻滞病史或肠切除后行端端吻合术的患者中使用。尽管观察到不良药物事件的发生率较低，但可能需要考虑使用遥测进行心动过缓监测。
