Neostigmine Methylsulfate and Skyla

• Generic Name: neostigmine
• Dosage Forms: n.a.
• Other Brand Names: Prostigmin, Bloxiverz

Postoperative reversal of the effects of nondepolarizing neuromuscular blocking agents (e.g., atracurium, cisatracurium, mivacurium, pancuronium, rocuronium, vecuronium). Use in conjunction with an anticholinergic agent (atropine sulfate or glycopyrrolate) to counteract adverse muscarinic effects (e.g., bradycardia, bradyarrhythmias, increased secretions, bronchoconstriction).

Reduces time to recovery of neuromuscular function (defined as a return of train-of-four [TOF] twitch ratio to 0.9).

Not effective in antagonizing deep levels of neuromuscular blockade; attempt reversal only after some degree of spontaneous recovery has occurred (e.g., when there is a detectable twitch response to the first TOF stimulus).

Do not use in patients with complete neuromuscular recovery; paradoxical neuromuscular effects (e.g., weakness of upper airway muscles, increased airway collapsibility) may occur. (See Neuromuscular Dysfunction under Cautions.)

Not effective and should not be used for reversal of depolarizing neuromuscular agents (e.g., succinylcholine).

Has been used for symptomatic treatment of myasthenia gravis to improve muscle strength; however, pyridostigmine generally preferred because of its longer duration of action and lower incidence of adverse muscarinic effects.

An oral preparation (neostigmine bromide; Prostigmin) previously used for this indication no longer is commercially available in the US.

Also has been used for diagnostic testing of myasthenia gravis, although edrophonium usually preferred.

Has been used for treatment of acute colonic pseudo-obstruction or Ogilvie syndrome. May be effective as second-line therapy in patients who fail conservative therapy.

Has been used as a prokinetic agent in patients with postoperative ileus following surgery; however, clinical usefulness may be limited by adverse muscarinic effects (e.g., bradycardia, increased bronchial secretions).

Has been used in the management of severe constipation in patients with thoracic spinal cord injury.

• Generic Name: levonorgestrel
• Dosage Forms: intrauterine device
• Other Brand Names: Skyla, Kyleena, Liletta, Mirena, Aftera, EContra EZ, EContra One-Step, Fallback Solo, My Choice, My Way, New Day, Next Choice One Dose, Opcicon One-Step, Plan B One-Step, React, Take Action, My Way, Next Choice

Skyla contains levonorgestrel, a female hormone that can cause changes in your cervical mucus and uterine lining, making it harder for sperm to reach the uterus and harder for a fertilized egg to attach to the uterus.

Skyla intrauterine device (IUD) is a small, flexible plastic T-shaped device. This device is placed in the uterus where it slowly releases the hormone to prevent pregnancy for 3 years. (Other types of levonorgestrel intrauterine systems release different amounts of hormone and are used for different lengths of time.)

Skyla can be used whether you have had children or not. It should not be used during pregnancy.

Levonorgestrel is a progestin hormone and does not contain estrogen. The Skyla IUD releases levonorgestrel in the uterus, but only small amounts of the hormone reach the bloodstream. Skyla should not be used as emergency birth control.