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Acetylcholinesterase Inhibitor / Neuromuscular Blockade Reversal

Neostigmine

Brand names: Neostigmine Methylsulfate

Neostigmine is an anticholinesterase used chiefly to reverse non-depolarising neuromuscular blockade at the end of anaesthesia, and also in conditions such as myasthenia gravis and post-operative ileus or urinary retention.

Dosing — being independently re-sourced

ClinCalc Pro is rebuilding its dose data from primary open sources — the manufacturer SmPC (eMC), the WHO Model Formulary and other official references — under clinician review. This drug's structured dose is not yet published here. Confirm all doses against the product SmPC and your local formulary before prescribing.

Clinical monograph

How it works

It reversibly inhibits acetylcholinesterase, increasing acetylcholine concentration at the neuromuscular junction and at muscarinic sites, thereby restoring transmission across the blocked junction.

Prescribing in practice

  • Its muscarinic effects (bradycardia, bronchoconstriction, increased secretions, salivation) require co-administration of an antimuscarinic such as glycopyrrolate or atropine.
  • It is ineffective and may be hazardous if given before some recovery of the block has occurred (it will not reverse a profound or deepening block).
  • It does not reverse depolarising (suxamethonium) blockade and may prolong it.

Monitoring

Monitor heart rate, neuromuscular recovery (train-of-four), and adequacy of ventilation during and after reversal.

Counselling the patient

  • This medicine is given by the anaesthetic team to help your muscles and breathing recover after surgery.
  • Increased saliva or a slow heartbeat can occur briefly and is managed by the team.

Evidence & guidelines

Use reflects established anaesthetic and neuromuscular practice; consult current prescribing references and the SPC.

Reference: AAGBI Guidelines; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. Monograph status: clinician-reviewed (2026-07-04).

Related

Curated clinical cross-links plus same-class fallbacks.

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