Neostigmine
Reversal of non-depolarising block: 50 micrograms/kg IV (max 5 mg) with glycopyrronium or atropine. Also used in myasthenia gravis.
On this page
Dose
| Indication | Dose |
|---|---|
| Reversal of block | 50 micrograms/kg IV (max 5 mg) with glycopyrronium 10 micrograms/kg or atropine |
| Myasthenia gravis | 15–30 mg orally several times daily (specialist; pyridostigmine more common) |
| Colonic pseudo-obstruction | 2 mg IV slowly with cardiac monitoring (specialist) |
Cautions
- Bradycardia, bronchospasm, salivation, abdominal cramps: give with an antimuscarinic.
- Avoid in mechanical bowel obstruction.
Frequently asked questions
Why is atropine given with neostigmine?
To block its effects on the heart (bradycardia) and secretions.
Used in these guides
Sources
Doses on this page are typical doses from the sources above. Always confirm with a current drug reference, the product leaflet and your hospital protocol, especially in children, pregnancy and kidney or liver disease.
For FCPS Part 1
Revising for FCPS Part 1? Neostigmine is covered in our textbook chapter Cholinergic drugs, with practice MCQs.