Neostigmine
Neostigmine is a cholinesterase inhibitor that increases acetylcholine levels at nerve synapses by preventing its breakdown. It is primarily used to reverse neuromuscular blockade after surgery and to treat myasthenia gravis, helping restore muscle function in patients with weak muscles.
Neostigmine is a cholinesterase inhibitor used to reverse muscle paralysis after surgery and manage myasthenia gravis.
Key facts at a glance
- ATC
- N07AA01
- RxNorm
- 7315
- Generic
- Neostigmine
- Class
- atc-n07
- Brands
- Bloxiverz, Prevduo
- Availability
- rx
- Lactation
- unknown
- Routes
- oral
- Forms
- prefilled syringe, solution, tablet
- Regions
- US, EU, CN, JP
- Monitoring
- —
This page is for informational purposes only.
Do not use this information to diagnose yourself or to replace a physician's advice. Always consult a qualified healthcare provider before starting, stopping, or changing any medication. If you believe you are experiencing a medical emergency, call your local emergency number immediately.
Dosage and administration
- Usual dose
- 15mg three times daily
- Maximum
- consult physician
- Frequency
- every 8 hours
- Instructions
- Follow physician instructions
- Duration limits
- as prescribed
- Monitoring
- standard
- Usual dose
- 0.3mg/kg/dose
- Maximum
- consult physician
- Frequency
- every 6-8 hours as needed
- Instructions
- Follow physician instructions
- Duration limits
- as prescribed
- Monitoring
- standard
- Usual dose
- 15mg twice daily
- Maximum
- consult physician
- Frequency
- every 12 hours
- Instructions
- Follow physician instructions
- Duration limits
- as prescribed
- Monitoring
- standard
Overdose information
Special Populations
10 groupspregnancy
first trimesteravoid if possible
use only if benefits outweigh potential risks to fetus
regular fetal monitoring
Use with caution and monitor for adverse effects.
pregnancy
second trimesteruse lowest effective dose
continue treatment if needed for myasthenia gravis control
fetal growth monitoring
Use with caution and monitor for adverse effects.
pregnancy
third trimesteruse lowest effective dose
consider timing of delivery, neostigmine may be used during labor
fetal monitoring during labor, watch for neonatal neuromuscular weakness
Use with caution and monitor for adverse effects.
lactation
breastfeedingno specific adjustment
compatible with breastfeeding but monitor infant for excessive salivation or weakness
observe infant for cholinergic symptoms
Use with caution and monitor for adverse effects.
geriatric
elderlystart with lower dose, titrate slowly
increased sensitivity to cholinergic effects, higher risk of bradycardia and hypotension
monitor heart rate and blood pressure closely
Use with caution and monitor for adverse effects.
pediatric_age
childrenweight-based dosing
commonly used for myasthenia gravis and neuromuscular blocker reversal in pediatric patients
monitor respiratory function, vital signs
renal_impairment
mildno major adjustment needed for mild impairment
monitor for accumulation, adjust if adverse effects occur
renal function monitoring
Use with caution and monitor for adverse effects.
renal_impairment
severereduce dose by 25-50%
significant accumulation expected, use with extreme caution
frequent renal function monitoring, watch for cholinergic toxicity
Use with caution and monitor for adverse effects.
hepatic_impairment
mild to moderateno major adjustment needed
primarily renally eliminated, hepatic metabolism minor
monitor liver function tests
Use with caution and monitor for adverse effects.
hepatic_impairment
severeuse with caution
limited data in severe hepatic impairment
monitor for accumulation
Use with caution and monitor for adverse effects.
Statistics and clinical data
Drug class
Pharmacological classification based on mechanism of action
Mechanism of action
Primary pharmacological mechanism
Common uses
Primary therapeutic indications
Commonly prescribed since
Historical prescribing information
Reversal of nondepolarizing neuromuscular blockade (e.g., after anesthesia), myasthenia gravis diagnosis and treatment, postoperative ileus, and urinary retention.
As a competitive cholinesterase inhibitor, neostigmine binds reversibly to acetylcholinesterase, preventing the breakdown of acetylcholine. This increases acetylcholine concentration in the synaptic cleft, allowing it to compete with neuromuscular blocking agents for receptor binding and restore muscle contraction.
Must be administered with an anticholinergic agent (e.g., glycopyrrolate or atropine) to prevent muscarinic side effects. Contraindicated in mechanical obstruction and with certain cardiac conditions. Requires close monitoring of respiratory function during reversal.
Contraindications
Conditions and patient states where this medication should be avoided or used with caution.
Do not use (1)
Known allergy to this medication or its components
Use caution (1)
Consult healthcare provider for benefits vs risks assessment
Official drug label
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This information is for educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment.
This content is for general informational and educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the guidance of a qualified healthcare provider with any questions you have about a medical condition, and never disregard professional medical advice or delay seeking it because of something you read here.
If you think you may have a medical emergency, call your local emergency number or go to the nearest emergency department immediately.
Medically reviewed by WellAlly Editorial Team Last reviewed July 26, 2026. · Read our editorial policy