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Neostigmine is used to treat symptoms of myasthenia gravis (neuromuscular disease characterized by very weak muscles and unusual tiredness). It is also used in paralytic Ileus (obstruction of the intestine due to paralysis of the intestinal muscles), post-operative urinary retention (difficulty urinating) and paroxysmal supraventricular tachycardia (episodes of rapid heart rate that start in a part of the heart above the ventricles).

How it works

Neostigmine belongs to a class of drugs called cholinesterase inhibitors. It works by improving the transmission of nerve impulses in muscles so that the muscles are able to work better.

Common side effects

Vomiting, Nausea, Frequent urge to urinate, Abnormal heart rhythm, Cough, Flatulence, Headache, Increased saliva production, Decreased blood pressure, Muscle weakness, Thickened respiratory tract secretions, Tingling sensation, Warm sensation, Worsening myasthenia gravis


Expert advice

  • You may need to stop using the medicine for a short time in case of a surgery.
  • Use neostigmine with caution if you have epilepsy, bronchial asthma, bradycardia, recent coronary occlusion, vagotonia, hyperthyroidism, cardiac arrhythmias, peptic ulcer.
  • Avoid taking large doses of neostigmine in situations where there might be an increased absorption rate from the intestinal tract. Use with caution when neostigmine is given along with anticholinergic drugs because of decreased GI motility.
  • Do not drive or operate machinery as neostigmine can cause blurred vision or impaired thinking.
  • Do not drink alcohol while taking neostigmine as it may worsen the side effects.
  • Take precautions while taking neostigmine as over dosage of neostigmine can cause extreme muscle weakness.

Frequently asked questions


Q. Is neostigmine an anticholinesterase/ anticholinergic/agonist/ cholinesterase inhibitor/ neurotransmitter?
Neostigmine is an anticholinesterase. But, it is not an anticholinergic, agonist, cholinesterase inhibitor or a neurotransmitter.
Q. Does neostigmine cause nausea?
Yes, neostigmine causes mild nausea.
Q. Does neostigmine reverse rocuronium/ reverse succinylcholine / inhibit pseudocholinesterase / cause histamine release?
Yes, Neostigmine causes reversal of rocuronium/ succinyl choline and inhibits pseudocholinesterease. It also causes histamine release.

Content on this page was last updated on 30 September, 2016, by Dr. Varun Gupta (MD Pharmacology)