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Neostigmine

Prescription

Acetylcholinesterase Inhibitor (Short-Acting)

Last reviewed 21 Apr 2026 · PetCare.AI Editorial Team

Species

Dog, Cat

Brands

2 available

Interactions

2 documented

Formulations

Mechanism of action

Reversibly inhibits acetylcholinesterase, preventing acetylcholine breakdown at the neuromuscular junction and all cholinergic synapses. Used to reverse non-depolarizing neuromuscular blockade and for myasthenia gravis (shorter-acting than pyridostigmine).

At a glance

Class

Acetylcholinesterase Inhibitor (Short-Acting)

Schedule

Prescription

Storage

Store at room temperature, protect from light

Dosing

🐕

Dog

Given with glycopyrrolate for NMB reversal to prevent profound bradycardia, sali

Dose

0.04–0.06 mg/kg

Route

IV, IM, SQ

Frequency

Once (NMB reversal); q6h (myasthenia gravis)

🐈

Cat

NMB reversal in cats

Dose

0.04 mg/kg

Route

Frequency

Single dose (NMB reversal)

Educational reference only

This information is provided for educational purposes and is not a substitute for professional veterinary advice, diagnosis, or treatment. Always consult a qualified veterinarian before administering any medication to your pet. Find a vet near you →

Formulations

💊

Other — 2

Strength

—

Strength

—

Storage

Store at room temperature, protect from light

Safety

Monitoring parameters

TOF (train-of-four) monitoring for NMB reversal adequacyHeart rate (concurrent glycopyrrolate essential)Respiratory adequacy post-reversal

Educational reference only

Interactions

Contraindicated — 1

Succinylcholine

contraindicated

Neostigmine inhibits acetylcholinesterase which normally degrades succinylcholine. Combined: massively prolonged depolarizing blockade (hours of paralysis).

Management: NEVER give neostigmine to reverse succinylcholine (depolarizing agent). Neostigmine only reverses NON-depolarizing agents (atracurium, vecuronium, rocuronium).

Moderate — 1

Glycopyrrolate

moderate

Neostigmine reverses neuromuscular blockade but simultaneously causes muscarinic side effects (bradycardia, salivation, bronchospasm). Glycopyrrolate blocks these muscarinic effects without crossing BBB.

Management: Always co-administer glycopyrrolate (0.01 mg/kg IV) with neostigmine for NMB reversal. Give simultaneously — matched onset times.

Educational reference only

Brands

Other markets

Prostigmin

Bloxiverz

FAQs

Frequently asked questions

›What is Neostigmine?

Neostigmine is a acetylcholinesterase inhibitor (short-acting) used in pets. Reversibly inhibits acetylcholinesterase, preventing acetylcholine breakdown at the neuromuscular junction and all cholinergic synapses. Used to reverse non-depolarizing neuromuscular blockade and for myasthenia gravis (shorter-acting than pyridostigmine).

›What is Neostigmine used for in pets?

Neostigmine is used in veterinary medicine for: Given with glycopyrrolate for NMB reversal to prevent profound bradycardia, sali; NMB reversal in cats.

›What is the Neostigmine dose for dogs?

For dogs, Neostigmine is typically dosed as follows — Given with glycopyrrolate for NMB reversal to prevent profound bradycardia, sali: 0.04–0.06 mg/kg IV/IM/SQ Once (NMB reversal); q6h (myasthenia gravis). Always consult your veterinarian for a dose tailored to your pet's weight, age, and condition.

›What is the Neostigmine dose for cats?

For cats, Neostigmine is typically dosed as follows — NMB reversal in cats: 0.04 mg/kg IV Single dose (NMB reversal). Always consult your veterinarian for a dose tailored to your pet's weight, age, and condition.

›Does Neostigmine need a prescription?

Yes. Neostigmine is a prescription medication and should only be administered under veterinary supervision.

Educational reference only

References

The PetCare.AI drug reference is built from 13 authoritative sources cited across 580 drug monographs.

Textbooks & handbooks — 5

Plumb's Veterinary Drug Handbook
Withrow & MacEwen's Small Animal Clinical Oncology
Merck Veterinary Manual
NRC Nutrient Requirements of Dogs and Cats
Veterinary Pharmacology and Therapeutics (Riviere & Papich)

Clinical guidelines & consensus — 4

ASPCA Animal Poison Control Center Guidelines
AAHA Diabetes Management Guidelines
ASPCA Poison Control Guidelines
RECOVER CPR Guidelines

Journals & peer-reviewed studies — 2

EPIC Study (J Vet Intern Med 2016)
JVIM FAT CAT Study

Regulatory & approvals — 1

CDSCO Veterinary Drug Approval Registry (1969–2026)

Databases — 1

Washington State University VCPL MDR1 Database