Neostigmine

(Prostigmin)

Neuromuscular Blocking Agents & Reversals

Neostigmine is a cholinesterase inhibitor that reverses non-depolarizing neuromuscular blockade by increasing acetylcholine concentration at the neuromuscular junction. It typically begins working within 5-10 minutes, with peak effect at 10-15 minutes. Neostigmine must be coadministered with an anticholinergic (glycopyrrolate or atropine) to counteract muscarinic side effects. The drug is ineffective against depolarizing blocks (succinylcholine) and may worsen phase II block. Neostigmine remains the most widely used reversal agent worldwide due to its low cost and reliability, though sugammadex offers faster and more complete reversal for aminosteroid NMBAs.