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The Japanese Journal of Gastroenterology 28:53755

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rocuronium, vecuronium, atracurium, cisatracurium) It is not effective against depolarizing skeletal muscle relaxants (succinylcholine) It may be used adjunctively in the treatment of respiratory depression caused by overdosage of curare like neuromuscular blockers Contraindications: Known hypersensitivity to anticholinesterase agents Intestinal and urinary obstructions of mechanical type Side Effects: The myasthenic patient in crisis who is being tested with edrophonium should be observed for bradycardia or cardiac standstill and cholinergic reactions if an overdose is given

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According to NICE Clinical Knowledge Summaries and the British National Formulary (BNF), the recommended treatment regimens are: For patients without neurological involvement : Initial treatment: hydroxocobalamin 1 mg intramuscularly three times a week for 2 weeks Maintenance: hydroxocobalamin 1 mg intramuscularly every 3 months for life For patients with neurological involvement : Initial treatment: hydroxocobalamin 1 mg intramuscularly on alternate days until no further improvement Maintenance: hydroxocobalamin 1 mg intramuscularly every 2 months for life If neurological symptoms are present, treatment should be started urgently to prevent irreversible damage