Prostigmin can have undesirable functional effects on the autonomic nervous system (ANS). Muscarinic effects can include nausea, vomiting, diarrhea, stomach cramps, increased peristalsis and bronchial secretion, salivation and lacrimation, bradycardia and miosis. The primary nicotinic effects are muscle spasms, fasciculations and muscular weakness.
Cholinergic reactions to Prostigmin can be particularly troublesome when Prostigmine is used to reverse the action of nondepolarising muscle relaxants. For this reason, combined injection of Prostigmin and atropine sulfate is recommended (see Dosage, Overdosage).
In addition, the following adverse effects were observed in patients that were given neostigmine: Allergy:
Allergic reactions and anaphylaxis. Neurologic:
Vertigo, convulsions, unconsciousness, tiredness, headache, dysarthria and visual disturbance. Cardiovascular:
Arrhythmia [including bradycardia, tachycardia, atrioventricular (AV) block and nodal rhythm] and unspecified electrocardiogram (ECG) variations, as well as cardiac arrest, syncope, and hypotension. This was observed particularly in patients that were given neostigmine parenterally. Respiratory:
Increased oral and bronchial secretion, dyspnea, respiratory depression, apnea and bronchospasm. Dermatologic:
Redness of skin, urticaria and rash. Gastrointestinal:
Nausea, vomiting, flatulence and increased peristalsis. Urogenital:
Increased urination. Bones and Muscles:
Muscle cramps and arthralgia. Miscellaneous:
Diaphoresis, facial redness, adynamia.