By Medically reviewed by hellodoktor

Generic Name: Neostigmine Brand Name(s): Generics only. No brands available.


What is neostigmine used for?

Neostigmine is a cholinesterase inhibitor. It works by improving the transmission of nerve impulses in muscles so that the muscles are better able to work.

Neostigmine is commonly used for treating myasthenia gravis. It may also be used for other conditions as determined by your doctor.

How should I take neostigmine?

Use neostigmine as directed by your doctor. Check the label on the medicine for exact dosing instructions.

Neostigmine may be taken with or without food. If stomach upset occurs, take with food to reduce stomach irritation.

Ask your health care provider any questions you may have about how to use neostigmine.

How do I store neostigmine?

Neostigmine is best stored at room temperature away from direct light and moisture. To prevent drug damage, you should not store neostigmine in the bathroom or the freezer. There may be different brands of neostigmine that may have different storage needs. It is important to always check the product package for instructions on storage, or ask your pharmacist. For safety, you should keep all medicines away from children and pets.

You should not flush neostigmine down the toilet or pour them into a drain unless instructed to do so. It is important to properly discard this product when it is expired or no longer needed. Consult your pharmacist for more details about how to safely discard your product.

Precautions & warnings

What should I know before using neostigmine?

Before using this drug, you should know that:

  • Neostigmine may cause drowsiness, dizziness, blurred vision, or fainting. Do not drive, operate machinery, or do anything else that could be dangerous until you know how you react to neostigmine. Using neostigmine alone, with certain other medicines, or with alcohol may lessen your ability to drive or perform other potentially dangerous tasks.
  • Before you have any medical or dental treatments, emergency care, or surgery, tell the doctor or dentist that you are using neostigmine.

Is it safe during pregnancy or breastfeeding?


If you become pregnant, discuss with your doctor the benefits and risks of using neostigmine during pregnancy. It is unknown if neostigmine is excreted in breast milk.


If you are or will be breastfeeding while you are using neostigmine, check with your doctor or pharmacist to discuss the risks to your baby.

Side effects

What side effects can occur from neostigmine?

All medicines may cause side effects, but many people have no, or minor, side effects. Check with your doctor if any of these most common side effects persist or become bothersome:

  • Abdominal cramps
  • Diarrhea
  • Difficulty speaking
  • Dilation of pupils
  • Dizziness
  • Drowsiness
  • Excess saliva
  • Frequent urination
  • Gas
  • Headache
  • Increased sweating
  • Joint pain
  • Muscle twitching
  • Weakness

Seek medical attention right away if any of these severe side effects occur:

  • Severe allergic reactions (rash; itching; hives; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue)
  • Fainting
  • Increased muscle weakness
  • Interrupted breathing
  • Irregular heartbeat
  • Seizures
  • Vision changes

Not everyone experiences these side effects. There may be some side effects not listed above. If you have any concerns about a side-effect, please consult your doctor or pharmacist.


What drugs may interact with neostigmine?

Neostigmine may interact with other drugs that you are currently taking, which can change how your drug works or increase your risk for serious side effects. To avoid any potential drug interactions, you should keep a list of all the drugs you are using (including prescription drugs, nonprescription drugs, and herbal products) and share it with your doctor and pharmacist. For your safety, do not start, stop, or change the dosage of any drugs without your doctor’s approval.

Products may interact with this drug, including:

  • General anesthetics (e.g., cyclopropane)
  • Procainamide
  • Quinine derivatives (e.g., quinidine)
  • Beta-blockers (e.g., propanolol) or succinylcholine

Does food or alcohol interact with neostigmine?

Neostigmine may interact with food or alcohol by altering the way the drug works or increase the risk for serious side effects. Please discuss with your doctor or pharmacist any potential food or alcohol interactions before using this drug.

What health conditions may interact with neostigmine?

Neostigmine may interact with your health condition. This interaction may worsen your health condition or alter the way the drug works. It is important to always let your doctor and pharmacist know all the health conditions you currently have.


The information provided is not a substitute for any medical advice. You should ALWAYS consult with your doctor or pharmacist before using neostigmine.

What is the dose of neostigmine for an adult?

Dosage requirements for optimal results vary from 15 mg to 375 mg per day. In some instances, it may be necessary to exceed these dosages, but the possibility of cholinergic crisis must be recognized.

The average dose is 10 tablets (150 mg) administered over a 24-hour period. The interval between doses is of paramount importance. The dosage schedule should be adjusted for each patient and changed as the need arises.

Frequently, therapy is required day and night. Larger portions of the total daily dose may be given at times when the patient is more prone to fatigue (afternoon, mealtimes, etc.). The patient should be encouraged to keep a daily record of his or her condition to assist the physician in determining an optimal therapeutic regimen.

What is the dose of neostigmine for a child?

The dosage has not been established in pediatric patients. It may be unsafe for your child. It is always important to fully understand the safety of the drug before using. Please consult with your doctor or pharmacist for more information.

How is neostigmine available?

Neostigmine is available in the following dosage forms and strengths:

  • Solution, Injection: 0.5 mg/ml (1 ml, 10 ml)
  • Tablet, Oral, 15 mg

What should I do in case of an emergency or overdose?

In case of an emergency or an overdose, call your local emergency services or go to your nearest emergency room.

What should I do if I miss a dose?

If you miss a dose of neostigmine, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and take your regular dose as scheduled. Do not take a double dose.

Hello Health Group does not provide medical advice, diagnosis or treatment.

Review Date: February 6, 2017 | Last Modified: September 12, 2019

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