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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
2

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
IV
Frequency
Single dose (NMB reversal)

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

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.

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.

References

References

Textbooks & handbooks

  • Plumb, D.C. Plumb's Veterinary Drug Handbook. 10th ed., Wiley-Blackwell, 2023.
  • Vail, D.M., Thamm, D.H., & Liptak, J.M. (eds.). Withrow & MacEwen's Small Animal Clinical Oncology. 6th ed., Saunders/Elsevier, 2020.
  • Riviere, J.E., & Papich, M.G. (eds.). Veterinary Pharmacology and Therapeutics. 10th ed., Wiley-Blackwell, 2018.
  • National Research Council. Nutrient Requirements of Dogs and Cats. National Academies Press, Washington DC, 2006.
  • The Merck Veterinary Manual. Merck & Co., Online edition. https://www.merckvetmanual.com/

Clinical guidelines & consensus

  • Fletcher, D.J., Boller, M., Brainard, B.M., et al. "RECOVER Evidence and Knowledge Gap Analysis on Veterinary CPR." Journal of Veterinary Emergency and Critical Care, 2012;22(S1):S102–S131.
  • American Animal Hospital Association. 2018 AAHA Diabetes Management Guidelines for Dogs and Cats. AAHA Press.

Journals & peer-reviewed studies

  • Hogan, D.F., Fox, P.R., Jacob, K., et al. "Secondary prevention of cardiogenic arterial thromboembolism in the cat: The FAT CAT study." Journal of Veterinary Cardiology, 2015;17(Suppl 1):S306–S317.
  • Boswood, A., Häggström, J., Gordon, S.G., et al. "Effect of Pimobendan in Dogs with Preclinical Myxomatous Mitral Valve Disease and Cardiomegaly: The EPIC Study — A Randomized Clinical Trial." Journal of Veterinary Internal Medicine, 2016;30(6):1765–1779.
  • ASPCA Animal Poison Control Center. Toxicology and Poison Management Guidelines. American Society for the Prevention of Cruelty to Animals. https://www.aspca.org/pet-care/animal-poison-control

Regulatory & approvals

  • Central Drugs Standard Control Organisation (CDSCO), Government of India. Veterinary Drug Approval Registry, 1969–2026. Directorate General of Health Services. https://cdsco.gov.in/

Databases

  • Washington State University, College of Veterinary Medicine. Veterinary Clinical Pharmacology Laboratory (VCPL) — MDR1 Multidrug Sensitivity Database. https://vcpl.vetmed.wsu.edu/
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 →