Neostigmine - The underutilized drug worth remembering.

Abstract

Ogilvie syndrome, a rare intestinal motility disorder associated with parasympathetic plexus dysfunction, can lead to severe complications like ischemia and perforation in hospitalized patients with significant comorbidities. This retrospective observational study assessed the efficacy and safety of neostigmine in treating Ogilvie syndrome at our center from January 2021 to December 2023. Thirteen patients received neostigmine after failing initial measures such as electrolyte correction, decompression, and intravenous prokinetics. Patients had a mean age of 66 years, predominantly male (77%), with 54% on polypharmacy. Neostigmine was administered in critical care settings under continuous monitoring. Symptom resolution occurred in 70% of cases, with a single dose achieving an 86% success rate in 54% of patients. Two doses were required for the remaining 46%, with a 50% success rate. No severe adverse reactions were observed. Neostigmine demonstrated high efficacy and safety in managing Ogilvie syndrome, highlighting its potential as a first-line therapeutic alternative to more invasive interventions.