acute colonic pseudo obstruction

Q: Give some of the side effects of using neostigmine in acute colonic pseudo-obstruction (Ogilvie's syndrome)?

Answer: Neostigmine is an acetylcholinesterase inhibitor used in acute colonic pseudo-obstruction (Ogilvie's syndrome) when conservative measures fail. Some of the side effects that need to be kept in mind are

• bradycardia
• hypotension
• asystole
• seizures
• restlessness
• tremor
• bronchoconstriction
• nausea
• vomiting
• salivation
• diarrhea
• sweating
• abdominal cramps

It should be used with caution in

• recent myocardial infarction
• acidosis
• asthma
• peptic ulcer disease
• concomitant use of beta-blockers

Side effects can be minimized by giving a lower dose or by coadministration of glycopyrrolate, an anticholinergic agent that has limited activity on the muscarinic receptors of the colon. Patient should be monitored closely, and atropine should be available at the bedside. Dose can be repeated if needed.

Neostigmine can also be given subcutaneously. It is also suggested to use polyethylene glycol after the resolution of colonic dilation to maintain its efficacy.

#GI

References:

Alavi K, Poylin V, Davids JS, et al. The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Management of Colonic Volvulus and Acute Colonic Pseudo-Obstruction. Dis Colon Rectum 2021; 64:1046.

Kram B, Greenland M, Grant M, et al. Efficacy and Safety of Subcutaneous Neostigmine for Ileus, Acute Colonic Pseudo-obstruction, or Refractory Constipation. Ann Pharmacother 2018; 52:505.

Sgouros SN, Vlachogiannakos J, Vassiliadis K, et al. Effect of polyethylene glycol electrolyte balanced solution on patients with acute colonic pseudo obstruction after resolution of colonic dilation: a prospective, randomised, placebo controlled trial. Gut 2006; 55:638.