Summary: A cholinesterase inhibitor used in the treatment of myasthenia gravis and to reverse the effects of muscle relaxants such as gallamine and tubocurarine. Neostigmine, unlike PHYSOSTIGMINE, does not cross the blood-brain barrier.

Top Publications

  1. Sacan O, White P, Tufanogullari B, Klein K. Sugammadex reversal of rocuronium-induced neuromuscular blockade: a comparison with neostigmine-glycopyrrolate and edrophonium-atropine. Anesth Analg. 2007;104:569-74 pubmed
    ..We tested the hypothesis that sugammadex would provide for a more rapid reversal of a moderately profound residual rocuronium-induced blockade than the commonly used cholinesterase inhibitors, edrophonium and neostigmine.
  2. Eikermann M, Fassbender P, Malhotra A, Takahashi M, Kubo S, Jordan A, et al. Unwarranted administration of acetylcholinesterase inhibitors can impair genioglossus and diaphragm muscle function. Anesthesiology. 2007;107:621-9 pubmed
    It is standard practice to administer a cholinesterase inhibitor (e.g., neostigmine) at the end of a surgical case to reverse suspected effects of neuromuscular blocking agents regardless of whether such residual effects are present...
  3. Breccia M, Girmenia C, Mecarocci S, Cartoni C, Carmosino I, Tafuri A, et al. Ogilvie's syndrome in acute myeloid leukemia: pharmacological approach with neostigmine. Ann Hematol. 2001;80:614-6 pubmed
    ..This process was associated with sepsis and resolved with conservative therapy of the underlying condition, using granulocyte colony-stimulating factor and intravenous neostigmine. We discuss the management of this rare syndrome.
  4. Grosse Sundrup M, Henneman J, Sandberg W, Bateman B, Uribe J, Nguyen N, et al. Intermediate acting non-depolarizing neuromuscular blocking agents and risk of postoperative respiratory complications: prospective propensity score matched cohort study. BMJ. 2012;345:e6329 pubmed publisher
    ..To determine whether use of intermediate acting neuromuscular blocking agents during general anesthesia increases the incidence of postoperative respiratory complications...
  5. Flockton E, Mastronardi P, Hunter J, Gomar C, Mirakhur R, Aguilera L, et al. Reversal of rocuronium-induced neuromuscular block with sugammadex is faster than reversal of cisatracurium-induced block with neostigmine. Br J Anaesth. 2008;100:622-30 pubmed publisher
    Reversal of the residual effect of rocuronium or cisatracurium by neostigmine may be slow and associated with side-effects...
  6. Ikemoto S, Wise R. Rewarding effects of the cholinergic agents carbachol and neostigmine in the posterior ventral tegmental area. J Neurosci. 2002;22:9895-904 pubmed
    ..of the cholinergic agonist carbachol (30-500 pmol per infusion) or the acetylcholinesterase inhibitor neostigmine (7.5-75 pmol per infusion) into the posterior ventral tegmental area (VTA) of the brain...
  7. Roelants F, Rizzo M, Lavand homme P. The effect of epidural neostigmine combined with ropivacaine and sufentanil on neuraxial analgesia during labor. Anesth Analg. 2003;96:1161-6, table of contents pubmed
    Spinal neostigmine produces analgesia without respiratory depression or hypotension but provokes major gastrointestinal side effects. Epidural injection of this drug, however, appears to induce analgesia devoid of such side effects...
  8. Yegin A, Yilmaz M, Karsli B, Erman M. Analgesic effects of intrathecal neostigmine in perianal surgery. Eur J Anaesthesiol. 2003;20:404-8 pubmed
    In recent human and animal studies, intrathecal administration of various doses of neostigmine produces analgesia without neurotoxicity...
  9. Joosen M, van Helden H. Correlations between acetylcholinesterase inhibition, acetylcholine levels and EEG changes during perfusion with neostigmine and N6-cyclopentyladenosine in rat brain. Eur J Pharmacol. 2007;555:122-8 pubmed
    ..EEG) changes was investigated during local perfusion of the reversible acetylcholinesterase inhibitor neostigmine in the hippocampus and striatum of freely moving rats...

More Information


  1. Batra Y, Arya V, Mahajan R, Chari P. Dose response study of caudal neostigmine for postoperative analgesia in paediatric patients undergoing genitourinary surgery. Paediatr Anaesth. 2003;13:515-21 pubmed
    b>Neostigmine given through the neuraxial route has been found to have analgesic properties...
  2. Roelants F, Lavand homme P, Mercier Fuzier V. Epidural administration of neostigmine and clonidine to induce labor analgesia: evaluation of efficacy and local anesthetic-sparing effect. Anesthesiology. 2005;102:1205-10 pubmed
    ..The authors have recently demonstrated that epidural neostigmine initiates selective labor analgesia devoid of adverse effects...
  3. Fu A. Neostigmine: an alternative treatment for constipation. Dynamics. 2005;16:13-5 pubmed
    ..Recent studies have shown neostigmine may be an effective treatment for ACPO...
  4. Dogan N, Erdem A, Erman Z, Kizilkaya M. The effects of bupivacaine and neostigmine on articular cartilage and synovium in the rabbit knee joint. J Int Med Res. 2004;32:513-9 pubmed
    We investigated the effects of intra-articular injections of bupivacaine and neostigmine on articular cartilage and the synovial membrane of rabbit knee joints...
  5. El Khodery S, Sato M. Ultrasonographic assessment of the reticular motility in cows after administration of different doses of metoclopramide and neostigmine. Vet Res Commun. 2008;32:473-80 pubmed publisher
    ..ultrasonography for assessment of reticular motility after administration of various doses of metclopramide and neostigmine in cows. A total of ten Holstein cows were used in six trials in each one single dose of each drug was used...
  6. McNamara R, Mihalakis M. Acute colonic pseudo-obstruction: rapid correction with neostigmine in the emergency department. J Emerg Med. 2008;35:167-70 pubmed publisher
    ..A diagnosis of acute colonic pseudo-obstruction was made and 2 mg of intravenous neostigmine was administered, with resolution of the patient's condition allowing for subsequent Emergency Department ..
  7. Chowdhury F, Nazmul Ahasan H, Mamunur Rashid A, Al Mamun A, Khaliduzzaman S. Tetrodotoxin poisoning: a clinical analysis, role of neostigmine and short-term outcome of 53 cases. Singapore Med J. 2007;48:830-3 pubmed
    ..In this paper, we aim to share our experience and to find out the toxic manifestations, lag period between ingestion of fish and development of symptoms, the short-term clinical outcome, and value of neostigmine in its management.
  8. Eikermann M, Zaremba S, Malhotra A, Jordan A, Rosow C, Chamberlin N. Neostigmine but not sugammadex impairs upper airway dilator muscle activity and breathing. Br J Anaesth. 2008;101:344-9 pubmed publisher
    ..Sugammadex reverses neuromuscular block by encapsulating rocuronium. However, its effects on upper airway integrity and breathing are unknown...
  9. Yoon S, Kwon Y, Kim H, Roh D, Kang S, Kim C, et al. Intrathecal neostigmine reduces the zymosan-induced inflammatory response in a mouse air pouch model via adrenomedullary activity: involvement of spinal muscarinic type 2 receptors. Neuropharmacology. 2005;49:275-82 pubmed
    Intrathecal (IT) injection of neostigmine (a cholinesterase inhibitor) has been reported to produce a significant anti-nociceptive effect in a number of inflammatory pain models...
  10. Ross V, Pan P, Owen M, Seid M, Harris L, Clyne B, et al. Neostigmine decreases bupivacaine use by patient-controlled epidural analgesia during labor: a randomized controlled study. Anesth Analg. 2009;109:524-31 pubmed publisher
    Intrathecal neostigmine not only produces analgesia but also severe nausea. In contrast, epidural neostigmine enhances opioid and local anesthetic analgesia without causing nausea...
  11. Taheri R, Shayeghi S, Razavi S, Sadeghi A, Ghabili K, Ghojazadeh M, et al. Efficacy of bupivacaine-neostigmine and bupivacaine-tramadol in caudal block in pediatric inguinal herniorrhaphy. Paediatr Anaesth. 2010;20:866-72 pubmed publisher
    ..Therefore, the purpose of this study was to evaluate the effectiveness and safety of bupivacaine in combination with either neostigmine or tramadol for caudal block in children undergoing inguinal herniorrhaphy.
  12. Bitzinger D, Zausig Y, Paech C, Gruber M, Busse H, Sinner B, et al. Modulation of immune functions in polymorphonuclear neutrophils induced by physostigmine, but not neostigmine, independent of cholinergic neurons. Immunobiology. 2013;218:1049-54 pubmed publisher
    ..We investigated the concentration-response-effects of physostigmine and neostigmine on the oxidative burst activity (human and rat PMN) and the expression of adhesion molecules on the surface of ..
  13. Lydic R, Douglas C, Baghdoyan H. Microinjection of neostigmine into the pontine reticular formation of C57BL/6J mouse enhances rapid eye movement sleep and depresses breathing. Sleep. 2002;25:835-41 pubmed
    ..The present study used microinjection of neostigmine into pontine reticular formation of mouse to test the hypothesis that enhancing pontine cholinergic ..
  14. Ledowski T, Preuss J, Schug S. The effects of neostigmine and glycopyrrolate on skin conductance as a measure of pain. Eur J Anaesthesiol. 2009;26:777-81 pubmed publisher
    ..In this context, the effects of cholinesterase inhibitors and anticholinergic drugs used for the reversal of muscle relaxants were investigated...
  15. Kumar P, Rudra A, Pan A, Acharya A. Caudal additives in pediatrics: a comparison among midazolam, ketamine, and neostigmine coadministered with bupivacaine. Anesth Analg. 2005;101:69-73, table of contents pubmed
    ..randomized double-blind clinical study, we assessed and compared the efficacy of ketamine, midazolam, and neostigmine coadministered with bupivacaine in a caudal epidural to provide intraoperative and postoperative pain relief...
  16. Marucio R, Luna S, Neto F, Minto B, Hatschbach E. Postoperative analgesic effects of epidural administration of neostigmine alone or in combination with morphine in ovariohysterectomized dogs. Am J Vet Res. 2008;69:854-60 pubmed publisher
    To evaluate analgesic effects of epidurally administered neostigmine alone or in combination with morphine in dogs after ovariohysterectomy. Animals-40 healthy bitches.
  17. Mehta R, John A, Nair P, Raj V, Mustafa C, Suvarna D, et al. Factors predicting successful outcome following neostigmine therapy in acute colonic pseudo-obstruction: a prospective study. J Gastroenterol Hepatol. 2006;21:459-61 pubmed
    To evaluate predictors of neostigmine response in patients with acute colonic pseudo-obstruction.
  18. Paton F, Paulden M, Chambers D, Heirs M, Duffy S, Hunter J, et al. Sugammadex compared with neostigmine/glycopyrrolate for routine reversal of neuromuscular block: a systematic review and economic evaluation. Br J Anaesth. 2010;105:558-67 pubmed publisher
    ..We performed a systematic review of randomized controlled trials of sugammadex compared with neostigmine/glycopyrrolate and an economic assessment of sugammadex for the reversal of moderate or profound neuromuscular ..
  19. Caliskan E, Turkoz A, Sener M, Bozdogan N, Gulcan O, Turkoz R. A prospective randomized double-blind study to determine the effect of thoracic epidural neostigmine on postoperative ileus after abdominal aortic surgery. Anesth Analg. 2008;106:959-64, table of contents pubmed publisher
    ..In this study, we evaluated the effect of epidurally administered neostigmine on postoperative ileus after abdominal aortic surgery.
  20. Kim T, Lee J, Kim M, Park Y, Lee D, Chung N, et al. Acute colonic pseudo-obstruction in postchemotherapy complication of brain tumor treated with neostigmine. J Pediatr Hematol Oncol. 2007;29:420-2 pubmed
    ..We report a 9-year-old boy with acute colonic pseudo-obstruction caused by chemotherapy for brain tumor who did not respond to initial supportive therapy, but who was successfully treated with neostigmine.
  21. Sun L, Zhang G, Zhang X, Liu Q, Liu J, Su D, et al. Combined administration of anisodamine and neostigmine produces anti-shock effects: involvement of ?7 nicotinic acetylcholine receptors. Acta Pharmacol Sin. 2012;33:761-6 pubmed publisher
    To evaluate the anti-effects of anisodamine and neostigmine in animal models of endotoxic and hemorrhagic shock.
  22. Imai K, Kitakoji H, Chihara E, Sakita M. Effects of atropine sulfate and neostigmine on gastric electrical activity in human subjects--electrogastrographic study. Hepatogastroenterology. 2008;55:294-7 pubmed
    ..To determine the effect of intravenous administration of a vagal blocker (atropine sulfate) or a vagal stimulator (neostigmine) on gastric electrical activities EGG was utilized in this study.
  23. Isbister G, Oakley P, Whyte I, Dawson A. Treatment of anticholinergic-induced ileus with neostigmine. Ann Emerg Med. 2001;38:689-93 pubmed
    ..Persistent ileus was treated with repeated doses of neostigmine, and gastrointestinal motility returned with prompt defecation...
  24. Yoon M, Park H, Kim W, Lee H, Kim Y, Huang L. Evaluation for the interaction between intrathecal melatonin and clonidine or neostigmine on formalin-induced nociception. Life Sci. 2008;83:845-50 pubmed publisher
    We examined the nature of pharmacological interaction after coadministration of melatonin with clonidine or neostigmine on formalin-induced nociception at the spinal level...
  25. Lee S, Lee J, Lee S, Lee J, Lee J. Calcium and neostigmine antagonize gentamicin, but augment clindamycin-induced tetanic fade in rat phrenic nerve-hemidiaphragm preparations. J Anesth. 2008;22:385-90 pubmed publisher
    A reduction in acetylcholine release induced by gentamicin may limit neostigmine-induced increases in acetylcholine concentration in the neuromuscular junction...
  26. Freeling J, Wattier K, LaCroix C, Li Y. Neostigmine and pilocarpine attenuated tumour necrosis factor alpha expression and cardiac hypertrophy in the heart with pressure overload. Exp Physiol. 2008;93:75-82 pubmed
    ..In the present study, we tested the effects of a cholinesterase inhibitor, neostigmine, and a muscarinic cholinergic agonist, pilocarpine, on cardiac hypertrophy and TNF alpha levels during pressure ..
  27. Maher L, Young P. Cardiac arrest complicating neostigmine use for bowel opening in a critically ill patient. Crit Care Resusc. 2011;13:192-3 pubmed
    Absence of bowel opening is common among critically ill patients. Neostigmine can be used to achieve stool passage after other treatments have been ineffective...
  28. Kim H, Park J, Kim S, Sun B, Koo S, Choi S, et al. Electroacupuncture potentiates the antiallodynic effect of intrathecal neostigmine in a rat model of neuropathic pain. J Physiol Sci. 2008;58:357-60 pubmed publisher
    This study was performed to examine whether electroacupuncture potentiates the neostigmine-induced antiallodynia in neuropathic pain rats. Although intrathecal neostigmine (0.05, 0.1, and 0...
  29. Blobner M, Eriksson L, Scholz J, Motsch J, Della Rocca G, Prins M. Reversal of rocuronium-induced neuromuscular blockade with sugammadex compared with neostigmine during sevoflurane anaesthesia: results of a randomised, controlled trial. Eur J Anaesthesiol. 2010;27:874-81 pubmed publisher
    ..This study compared the efficacy of sugammadex and neostigmine for reversal of neuromuscular blockade induced by rocuronium for facilitating elective surgery.
  30. Hazizaj A, Hatija A. Bronchospasm caused by neostigmine. Eur J Anaesthesiol. 2006;23:85-6 pubmed
  31. Akinci S, Ulu N, Yondem O, Firat P, Guc M, Kanbak M, et al. Effect of neostigmine on organ injury in murine endotoxemia: missing facts about the cholinergic antiinflammatory pathway. World J Surg. 2005;29:1483-9 pubmed
    ..b>Neostigmine, a cholinergic agent, has not been tested to determine if it can prevent histopathologic organ injury in ..
  32. Park C, Joo Y, Kim H, Choi S, Rew J, Kim S. Neostigmine for the treatment of acute hepatic encephalopathy with acute intestinal pseudo-obstruction in a cirrhotic patient. J Korean Med Sci. 2005;20:150-2 pubmed
    We treated a 49-yr-old man with neostigmine, who had liver cirrhosis, acute hepatic encephalopathy, and acute intestinal pseudoobstruction. He was admitted in a state of hepatic confusion...
  33. Roelants F. The use of neuraxial adjuvant drugs (neostigmine, clonidine) in obstetrics. Curr Opin Anaesthesiol. 2006;19:233-7 pubmed
    ..Opioids are used in routinely, but alpha2-agonists, such as clonidine or cholinesterase inhibitors (neostigmine), have also been used for labour analgesia or to relieve pain following caesarean section...
  34. Hofer S, Eisenbach C, Lukic I, Schneider L, Bode K, Brueckmann M, et al. Pharmacologic cholinesterase inhibition improves survival in experimental sepsis. Crit Care Med. 2008;36:404-8 pubmed
    ..Here we studied whether the cholinergic anti-inflammatory pathway can be activated by pharmacologic cholinesterase inhibition in vivo...
  35. Turan A, Karamanlýoglu B, Memis D, Kaya G, Pamukcu Z. Intravenous regional anesthesia using prilocaine and neostigmine. Anesth Analg. 2002;95:1419-22, table of contents pubmed
    b>Neostigmine has been added to local anesthetics for central and peripheral nerve blocks resulting in prolonged, increased anesthesia and improved analgesia...
  36. Omais M, Lauretti G, Paccola C. Epidural morphine and neostigmine for postoperative analgesia after orthopedic surgery. Anesth Analg. 2002;95:1698-701, table of contents pubmed
    In this study, we examined the side effects and analgesia of the combination of epidural neostigmine and morphine in patients undergoing orthopedic surgery. Sixty patients undergoing knee surgery were divided into four groups...
  37. Khosla A, Ponsky T. Acute colonic pseudoobstruction in a child with sickle cell disease treated with neostigmine. J Pediatr Surg. 2008;43:2281-4 pubmed publisher
    ..pediatric case of acute pseudoobstruction secondary to sickle cell disease that was treated successfully with neostigmine. Early recognition of this phenomenon is important as it alters patient management, can be treated medically, ..
  38. Emirleroglu M, Ekci B, Durgun V. The effect of neostigmine on postoperative ileus and the healing of colon anastomoses. Bratisl Lek Listy. 2011;112:309-13 pubmed
    The aim of this study was to assess the effects of neostigmine on the postoperative ileus and the healing of colon anastomoses.
  39. Roelants F, Lavand homme P. Epidural neostigmine combined with sufentanil provides balanced and selective analgesia in early labor. Anesthesiology. 2004;101:439-44 pubmed
    This study evaluated the efficacy of an epidural single dose of neostigmine combined with sufentanil to provide selective and balanced analgesia at the beginning of labor.
  40. Herbstreit F, Zigrahn D, Ochterbeck C, Peters J, Eikermann M. Neostigmine/glycopyrrolate administered after recovery from neuromuscular block increases upper airway collapsibility by decreasing genioglossus muscle activity in response to negative pharyngeal pressure. Anesthesiology. 2010;113:1280-8 pubmed publisher
    Reversal of residual neuromuscular blockade by acetylcholinesterase inhibitors (e.g., neostigmine) improves respiratory function. However, neostigmine may also impair muscle strength...
  41. McCartney C, Brill S, Rawson R, Sanandaji K, Iagounova A, Chan V. No anesthetic or analgesic benefit of neostigmine 1 mg added to intravenous regional anesthesia with lidocaine 0.5% for hand surgery. Reg Anesth Pain Med. 2003;28:414-7 pubmed
    b>Neostigmine has shown analgesic benefit when used as an adjunct to epidural or intrathecal anesthesia and analgesia, but evidence of benefit in the peripheral nervous system is controversial...
  42. Yoon M, Choi J, Kwak S. Characteristic of interactions between intrathecal gabapentin and either clonidine or neostigmine in the formalin test. Anesth Analg. 2004;98:1374-9, table of contents pubmed
    ..Unlike gabapentin, intrathecal clonidine and neostigmine attenuate both acute pain and phase 2 of the formalin response...
  43. D Angelo R, Dean L, Meister G, Nelson K. Neostigmine combined with bupivacaine, clonidine, and sufentanil for spinal labor analgesia. Anesth Analg. 2001;93:1560-4, table of contents pubmed
    ..We sought to determine whether the addition of spinal neostigmine to these drugs would further enhance labor analgesia...
  44. Kiba T, Numata K, Saito S. Neostigmine and polyethylene glycol electrolyte solution for the therapy of acute hepatic encephalopathy with liver cirrhosis and ascites. Hepatogastroenterology. 2003;50:823-6 pubmed who had non-B and non-C, and Child's class C liver cirrhosis and acute hepatic encephalopathy with neostigmine and polyethylene glycol electrolyte solution...
  45. Kaya F, Sahin S, Owen M, Eisenach J. Epidural neostigmine produces analgesia but also sedation in women after cesarean delivery. Anesthesiology. 2004;100:381-5 pubmed
    Intrathecal neostigmine produces analgesia but also nausea, limiting its utility. In contrast, epidural administration of neostigmine has been suggested to produce postoperative analgesia without nausea in nonpregnant patients...
  46. Anil A, Singh S, Bhalla A, Sharma N, Agarwal R, Simpson I. Role of neostigmine and polyvalent antivenom in Indian common krait (Bungarus caeruleus) bite. J Infect Public Health. 2010;3:83-7 pubmed publisher
    ..This study was undertaken to find the effectiveness of neostigmine and polyvalent antivenom in improving neuromuscular paralysis following bite...
  47. Yu Q, Holloway H, Luo W, Lahiri D, Brossi A, Greig N. Long-acting anticholinesterases for myasthenia gravis: synthesis and activities of quaternary phenylcarbamates of neostigmine, pyridostigmine and physostigmine. Bioorg Med Chem. 2010;18:4687-93 pubmed publisher
    The N-monophenylcarbamate analogues of neostigmine methyl sulfate (6) and pyridostigmine bromide (8) together with their precursors (5), (7), and the N(1)-methylammonium analogues of (-)-phenserine (12), (-)-tolserine (14), (-)-cymserine ..
  48. Fuchs Buder T, Meistelman C, Alla F, Grandjean A, Wuthrich Y, Donati F. Antagonism of low degrees of atracurium-induced neuromuscular blockade: dose-effect relationship for neostigmine. Anesthesiology. 2010;112:34-40 pubmed publisher
    ..This may be of clinical interest because a high dose of neostigmine given at a shallow level of neuromuscular block may produce neuromuscular weakness...
  49. Prado W, Dias T. Postoperative analgesia induced by intrathecal neostigmine or bethanechol in rats. Clin Exp Pharmacol Physiol. 2009;36:648-54 pubmed publisher
    1. Cholinergic agonists and acetylcholinesterase inhibitors, such as neostigmine, produce a muscarinic receptor-mediated antinociception in several animal species that depends on activation of spinal cholinergic neurons...
  50. Wittek T, Constable P. Assessment of the effects of erythromycin, neostigmine, and metoclopramide on abomasal motility and emptying rate in calves. Am J Vet Res. 2005;66:545-52 pubmed
    To determine and compare the effects of erythromycin, neostigmine, and metoclopramide on abomasal motility and emptying rate in suckling calves.
  51. Jones R, Caldwell J, Brull S, Soto R. Reversal of profound rocuronium-induced blockade with sugammadex: a randomized comparison with neostigmine. Anesthesiology. 2008;109:816-24 pubmed publisher
    ..Sugammadex is a novel reversal agent, reversing the effects of rocuronium by encapsulation. This study assessed the efficacy and safety of sugammadex versus neostigmine for reversal of profound rocuronium-induced neuromuscular blockade.
  52. Chia Y, Chang T, Liu K, Chang H, Ko N, Wang Y. The efficacy of thoracic epidural neostigmine infusion after thoracotomy. Anesth Analg. 2006;102:201-8 pubmed
    Few anesthesia studies have explored perioperative continuous epidural infusion of neostigmine. We examined such a regimen in thoracotomy patients. Ninety patients were randomized to one of three groups in this double-blind trial...
  53. Kida K, Ohtani N, Shoji K, Yasui Y, Masaki E. Postoperative pain status after intraoperative systemic dexmedetomidine and epidural neostigmine in patients undergoing lower abdominal surgery. Eur J Anaesthesiol. 2008;25:869-75 pubmed publisher
    To determine whether intraoperative systemic dexmedetomidine improves postoperative pain and interacts with epidural neostigmine to produce analgesic effects.