Acute colonic pseudo-obstruction: Off-label use of neostigmine is acute colonic pseudo-obstruction.Neurogenic bladder: Bethanechol may help complete bladder emptying in those with a hypotonic bladder.Bethanechol is the indicated pharmaceutical treatment of acute postoperative and postpartum non-obstructive urinary retention. Postoperative urinary retention: For both prevention and treatment of urinary distention and retention, neostigmine is a common option. ![]() Reversal of nondepolarizing neuromuscular blockade after surgery: Neostigmine preceded by atropine to block muscarinic effects, rapidly reverses muscle paralysis induced by neuromuscular blockers and is approved by the FDA.Pilocarpine is used off label to counter the effects of cycloplegics. Sequential use of atropine (mydriatic) and pilocarpine (miotic) is used to break iris-lens adhesions. Carbachol has utility with intraocular use as a miotic in surgery. Miotics are used as an add on therapy and are now third-choice drugs. Ophthalmology: Pilocarpine and carbachol work by increasing the aqueous outflow and hence decrease the intra-ocular tension in open-angle glaucoma. ![]() These medications have off label use for dementia from Parkinson disease and Lewy body dementia. Their primary use is in mild to moderate Alzheimer disease.
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