A Single-Center,Randomized Controlled Study on Neostigmine Acupoint Injection at Zusanli(ST36) for Treating Mechanical Ventilation-Associated Gastrointestinal Dysfunction

Mechanical ventilation is a common method of respiratory support for critically ill patients, and gastrointestinal dysfunction (GIDF) is a frequent complication. In the ICU, more than 60% of mechanically ventilated patients experience gastrointestinal dysfunction. Currently, the exact causes of mechanical ventilation-induced gastrointestinal dysfunction remain unclear, but they primarily include increased intra-abdominal pressure resulting from positive-pressure ventilation, which inhibits gastrointestinal motility; inflammatory responses, prolonged bed rest, electrolyte imbalances, and the use of sedatives, analgesics, and even muscle relaxants . Manifestations such as gastroparesis and constipation further lead to delayed gastric emptying, increased intra-abdominal pressure, and heightened risks of bacterial translocation, multiple organ failure, and ventilator-associated pneumonia. Primary Objective is to investigate, through a prospective randomized controlled trial, the efficacy of neostigmine injection at the Zusanli acupoint compared to Zusanli acupoint stimulation alone or subcutaneous neostigmine injection in improving gastrointestinal function in patients with mechanical ventilation and gastrointestinal dysfunction. Secondary objectives: （1）To evaluate the effects of acupoint injection of neostigmine on the duration of mechanical ventilation, enteral nutrition intake, and ICU length of stay in critically ill patients; （2）To assess the safety of acupoint injection of neostigmine.

Start Date01 Jul 2026

Sponsor / Collaborator

Southeast University

NCT06685705

/ Not yet recruitingPhase 4IIT

Comparative Study Between Intrathecal Magnesium Sulfate, Neostigmine and Fentanyl As Adjuvant for Bubivacaine in Postoperative Analgesia in Lower Abdominal Surgeries

Lower abdominal surgeries often result in severe pain, which in turn can cause rapid and shallow breathing, retention of secretions and poor patient compliance. Justifiably, apart from the fear for the surgery outcome, patients are concerned mainly with postoperative pain. If treated inadequately, acute pain can have serious consequences for patient health mainly with postoperative complications, prolonged recovery and increased length of hospital stay. Higher levels of postoperative pain and pain distress are associated with increased morbidity, poorer functional recovery, and reduced quality of life.
Aim of the study To compare the duration, quality of analgesia, and side effects between intrathecal Magnesium sulfate, neostigmine and fentanyl as adjuvant for bubivacaine as postoperative analgesia in lower abdominal surgeries

Start Date01 Dec 2024

Sponsor / Collaborator

Assiut University

CTRI/2023/07/055054

/ CompletedPhase 4

Effect of neostigmine on attenuation of proinflammatory cytokines secretion when given as an adjunctive therapy in septic shock: A Randomized controlled trial - NIL

Start Date20 Jul 2023

Sponsor / Collaborator

All India Institute of Medical Sciences

100 Clinical Results associated with Neostigmine Bromide

100 Translational Medicine associated with Neostigmine Bromide

100 Patents (Medical) associated with Neostigmine Bromide

4,738

Literatures (Medical) associated with Neostigmine Bromide

01 Oct 2026·TOXICON

Late emergence of myasthenia gravis complicating envenoming by Vipera ammodytes

Article

Author: Babulovska, Aleksandra ; Kostadinovski, Kristin ; Simonovska, Natasha K ; Naumoski, Kiril ; Dimitrovska, Irena

INTRODUCTION:

Vipera ammodytes, is the most important medically venomous snake in North Macedonia and one of the most dangerous species in Europe.

CASE PRESENTATION:

A 41-year-old construction worker sustained a bite to the distal phalanx of his right thumb while lifting a brick. The injury was followed by local swelling and visual disturbances. Initial management at a regional medical center included administration of specific antivenom, tetanus prophylaxis, methylprednisolone, chloropyramine, prophylactic anticoagulation, and antibiotic therapy, resulting in transient clinical improvement. Over the following two weeks, the patient developed progressive neurological symptoms, including headache, dizziness, bilateral ptosis, diplopia, transient vision loss, worsening dysphagia, generalized muscle weakness, and fatigue. He was referred to a tertiary toxicology clinic, where an acute myasthenic syndrome was suspected. A diagnostic trial with subcutaneous neostigmine combined with atropine led to rapid improvement of ptosis, confirming a cholinesterase inhibition response. Treatment with pyridostigmine and prednisone was initiated. After discharge, the patient initially improved but discontinued therapy on his own after three weeks. Six months later, during follow-up, neurological symptoms worsened, including increased weakness in the right hand. Additionally, he developed deformity and limited mobility of the distal interphalangeal joint at the bite site. After neurological reassessment, treatment was resumed, and regular follow-up examinations were scheduled thereafter.

CONCLUSION:

Although the acute management of snakebite envenomation primarily focuses on life-threatening complications, less severe venom-related effects may be overlooked during this stage. Therefore, long-term monitoring of the patient's clinical status is necessary, with periodic reassessment and adjustment of the therapeutic approach.

01 Oct 2026·TOXICON

Comparison of the efficacy of varespladib and coral snake antivenom against the activities of the Amazon coral snake (Micrurus spixii) venom

Article

Author: da Rocha, Marisa M T ; Serino-Silva, Caroline ; Cantuaria, Nathalia M ; Passos, Fernanda R ; Prezoto, Benedito Carlos ; Floriano, Rafael S ; Oshima-Franco, Yoko ; Gutiérrez, José María ; Lewin, Matthew ; Hyslop, Stephen

The ability of varespladib (VPL), a phospholipase A₂ (PLA₂) inhibitor, to attenuate several activities of the Amazon coral snake (Micrurus spixii) venom was assessed. The neutralization by VPL was compared to that of coral snake antivenom and, in some cases, neostigmine. The venom showed anticoagulant activity in human plasma (assessed using in vitro thromboelastometry), and was myotoxic (based on the increase in serum creatine kinase activity) and lethal to mice, in addition to causing neuromuscular blockade in chick isolated biventer cervicis preparations. Antivenom fully protected against lethality but only partially neutralized the other activities at the doses tested. VPL attenuated PLA₂-dependent effects, including anticoagulant activity and myotoxicity, but did not abrogate lethality. A combination of VPL and antivenom was also effective against anticoagulant activity and myotoxicity. Antivenom and VPL were partially effective for inhibiting the neuromuscular blockade induced by the venom, suggesting that toxins other than PLA₂s might be also involved. Antivenom and Varespladib combined have a higher inhibition than each of them alone against anticoagulant, myotoxic and neuromuscular blocking effects. Neostigmine, an anticholinesterase drug, showed only modest protection against lethality and neuromuscular blockade. These findings suggest that VPL could be a potential adjunct to conventional antivenom therapy in treating envenomation by M. spixii.

05 Aug 2026·AMERICAN JOURNAL OF HEALTH-SYSTEM PHARMACY

Beyond the hype: Understanding the limitations of sugammadex

Review

Author: Renew, J Ross ; Linn, Dustin D ; Brull, Sorin J

Abstract:

Purpose:

Sugammadex rapidly and effectively reverses aminosteroidal neuromuscular blocking agents and has largely replaced neostigmine in perioperative practice. Although its use is associated with faster recovery and a lower rate of residual neuromuscular blockade, clinically important limitations exist. This review summarizes the literature describing incomplete reversal, recurrence of neuromuscular blockade, adverse effects, drug interactions, and challenges in special populations, with a focus on the role of quantitative neuromuscular monitoring and pharmacist-led activities to optimize sugammadex use.

Summary:

While sugammadex substantially reduces the risk of residual neuromuscular blockade compared to neostigmine, incomplete reversal and recurrence of neuromuscular blockade continue to occur, particularly when dosing is not guided by quantitative neuromuscular monitoring. Underdosing, redistribution of neuromuscular blocking agents, and altered pharmacokinetics can all contribute to inconsistent responses. Quantitative neuromuscular monitoring, rather than choice of reversal agent, is the main determinant of reliable neuromuscular recovery and reduced occurrence of postoperative complications. Sugammadex is associated with rare but potentially serious adverse effects, including hypersensitivity reactions and cardiovascular instability, highlighting the need for careful monitoring. Patent expiration and generic availability may expand access to sugammadex, and these limitations warrant continued attention.

Conclusion:

Sugammadex represents a major advance in neuromuscular blockade reversal but remains an imperfect agent. Safe and effective use requires individualized dosing guided by quantitative neuromuscular monitoring and vigilance for adverse effects. Pharmacists are well positioned to lead education, dosing protocol development, and monitoring strategies that optimize patient safety while supporting adoption of quantitative neuromuscular monitoring.

News (Medical) associated with Neostigmine Bromide

14 Jul 2026

·www.prnewswire.com

B. Braun Announces Approval and Commercialization of First Generic Sugammadex Injection in the U.S. Market

BETHLEHEM, Pa., July 14, 2026 /PRNewswire/ -- B. Braun Medical Inc. (B. Braun), a recognized leader in smart infusion therapy and pharmaceutical manufacturing, announced the U.S. Food and Drug Administration (FDA) approval of Sugammadex Injection, 200 mg/2 mL (100 mg/mL), AP-rated generic BRIDION®1* (Sugammadex Injection) in the U.S. market. The product, which will be available July 28, 2026 in a single-dose vial with a 24-month shelf life, represents B. Braun's first launch of a generic pharmaceutical vial in the U.S. market. Sugammadex is indicated for the reversal of neuromuscular blockade induced by rocuronium bromide. In clinical studies, Sugammadex Injection demonstrated faster recovery compared to neostigmine and was associated with fewer adverse events in clinical studies.2 "With the launch of Sugammadex Injection, B. Braun is continuing to expand our portfolio of essential injectable medications used in acute care settings," said Jeremy Greene, Senior Director, Pharma Marketing. "This AP-rated generic option provides healthcare systems with an affordable solution and reliable supply of a critical anesthesia reversal agent. The addition helps us continue supporting hospitals and providers in delivering patient care." References U.S. Food and Drug Administration. Approved Drug Products with Therapeutic Equivalence Evaluations (Orange Book). Sugammadex sodium listing. Accessed May 20, 2026. American Society of Anesthesiologists. 2023 American Society of Anesthesiologists practice guidelines. Anesthesiology, 2023. About B. Braun B. Braun Medical Inc. (B. Braun) is a leader in smart infusion therapy and safe and effective pharmacy products, patient and provider safety, and sustainable health solutions. Our purpose is to help providers constantly improve patient satisfaction and outcomes. With products and services created to help healthcare professionals focus on what matters most—their patients—we're uniquely positioned to help health systems succeed now and in the future. B. Braun is headquartered in Bethlehem, Pennsylvania and is part of the B. Braun Group of Companies in the U.S., which includes B. Braun Interventional Systems, Aesculap® and CAPS®. The company employs 8,500 people at over 30 locations across North America. Globally, the B. Braun Group of Companies employs more than 64,000 employees in 64 countries. Guided by its Sharing Expertise® philosophy, B. Braun continuously exchanges knowledge with customers, partners and clinicians to address the critical issues of improving care and lowering costs. To learn more about B. Braun Medical, explore our website. SOURCE B. Braun Medical Inc. 21% more press release views with Request a Demo

Drug Approval

100 Deals associated with Neostigmine Bromide

External Link

KEGG	Wiki	ATC	Drug Bank
D00995	Neostigmine Bromide	S01EB06 N07AA01	DBSALT001191

R&D Status

10 top approved records.

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Indication	Country/Location	Organization	Date
Chronic gastritis	Japan	Kyowa Pharmaceutical Industry Co., Ltd.	14 Apr 1956
Constipation - functional	Japan	Kyowa Pharmaceutical Industry Co., Ltd.	14 Apr 1956
Dysuria	Japan	Kyowa Pharmaceutical Industry Co., Ltd.	14 Apr 1956
Myasthenia Gravis	Japan	Kyowa Pharmaceutical Industry Co., Ltd.	14 Apr 1956

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