Q: 67 year old male is admitted to ICU with acute colonic pseudo-obstruction and cecal diameter >11 cm. There was no resolution of symptoms with all conservative treatment. Decision was made to use Neostigmine. Which one trick may help to reduce the side effect of bradycardia and bronchoconstriction?
Answer: Coadministration of glycopyrrolate
Neostigmine can be used to relieve acute colonic pseudo-obstruction when conservative treatments remain ineffective. The usual dose is 2 mg IV given over 5 minutes. Being an acetylcholinesterase inhibitor, neostigmine carries the risk of causing bradycardia and bronchoconstriction. Coadministration of glycopyrrolate, which is an anticholinergic agent and may have some activity on the muscarinic receptors of the colon, may help to reduce these side effects.
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Reference:
Korsten MA, Rosman AS, Ng A, et al. Infusion of neostigmine-glycopyrrolate for bowel evacuation in persons with spinal cord injury. Am J Gastroenterol 2005; 100:1560.
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