Adult: Initially, 5 mg once daily for the 1st week, then increase to 7.5 mg once daily for the 2nd week, and then increase to 10 mg once daily for the 3rd week. Individualise dose based on symptom severity and patient tolerance.
Oral Neurogenic bladder disorders
Adult: 5 mg once daily. Dosage and treatment recommendations may vary among countries and between individual products (refer to specific product guidelines).
Oral Chronic hypotonic constipation, Megacolon
Adult: Initially, 2.5 mg once daily; may increase by 2.5 mg daily every 3 days, if needed. Max: 10 mg daily. Continue treatment until normal intestinal function has been restored (10-14 days).
Administration
Distigmine bromide Should be taken on an empty stomach. Take 30 min before breakfast.
Contraindications
Mechanical obstruction or spasms of the gastrointestinal tract or urinary tract; enteritis, gastric ulcer, gastrointestinal hyperacidity or hyperperistalsis, increased salivation; severe vagotonia accompanied by hypotension and bradycardia; postoperative shock, circulatory crisis, severe hypotension, untreated cardiac insufficiency; recent MI; CHF; cardiac arrhythmias (particularly bradycardia and AV block); peripheral circulatory disorder, tetany, Parkinson's disease, epilepsy, iritis, myotonia, bronchial asthma, thyrotoxicosis.
Special Precautions
Patient with hyperthyroidism, recent intestinal or bladder surgery. Pregnancy and lactation.
This drug may cause visual disturbances and impaired mental alertness, if affected, do not drive or operate machinery.
Monitoring Parameters
Monitor blood pressure and heart rate.
Overdosage
Symptoms: Cholinergic crisis characterised by excessive sweating, lacrimation, ciliary spasm, nystagmus, miosis, increased peristalsis, involuntary defaecation and urination, hypotension, bradycardia and other arrhythmias, muscle cramps, fasciculations, weakness and paralysis, wheezing, chest tightness, increased bronchial secretion with bronchoconstriction, blood pressure drop, paradoxical tachycardia, and bronchospasm; CNS effects, including ataxia, convulsions, slurred speech, restlessness, agitation, fear and coma.
Management: Supportive treatment. Administer oxygen and initiate assisted respiration as required. Discontinue administration immediately. In more severe poisoning, perform gastric emptying by aspiration. Atropine (1-2 mg; may give up to 4 mg, preferably IV or IM) may be given as an antidote for muscarinic effects; administration may be repeated as needed until signs of mild atropism (e.g. dry mouth, mydriasis) appear.
Drug Interactions
May enhance the effects of suxamethonium chloride. May increase the bradycardic effect of β-blockers. Decreased therapeutic effect with certain aminoglycoside antibiotics (e.g. neomycin, streptomycin, kanamycin) and dipyridamole. May increase adverse effects (e.g. increased muscular weakness) with corticosteroids.
Action
Description: Overview: Distigmine bromide is a quaternary ammonium compound. Mechanism of Action: Distigmine bromide binds reversibly to acetylcholinesterase, the enzyme responsible for acetylcholine destruction, thus prolonging cholinergic activity. Pharmacokinetics: Absorption: Poorly absorbed from the gastrointestinal tract. Bioavailability: 5%. Distribution: Penetrates the CNS poorly. Metabolism: Metabolised by plasma esterases via hydrolysis. Excretion: Via faeces (88%); urine (6.5%). Elimination half-life: 70 hours.
Chemical Structure
Distigmine bromide Source: National Center for Biotechnology Information. PubChem Compound Summary for CID 27522, Distigmine Bromide. https://pubchem.ncbi.nlm.nih.gov/compound/Distigmine-Bromide. Accessed Sept. 29, 2025.
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