Why have I been prescribed this medication?

Neostigmine bromide is prescribed as a reverse muscle relaxant and is used to improve muscle strength in patients with myasthenia gravis.

How it works

Neostigmine is another example of an Acetylcholinesterase inhibitor, or anticholinesterase. Acetylcholinesterase is the enzyme responsible for breaking down Acetylcholine. In patients with myasthenia, Acetylcholine is unable to bind to its receptor due to blockage by autoantibodies. By reducing levels of the enzyme responsible for breaking it down, Neostigmine increases the amount of free Acetylcholine in the body and therefore increases the rate of successful interaction. The difference between Neostigmine and Pyridostigmine is that Pyridostigmine has a slower onset of action and longer duration of action when compared to Neostigmine. Some patients may benefit from this, others may prefer a quicker release of the drug.

How it is delivered

Neostigmine can be delivered orally, or by subcutaneous (to the fat under the skin) or intramuscular (deep into the muscle) injection.

When you have it and how long you will be taking it

The dose is delivered daily, either orally or by injection, depending on prescription. It is taken when you feel you will most need the boost to your strength, such as before mealtimes or when you wake up.

Side effects

All medicines can cause unwanted side effects which usually improve as your body adjusts to the new medicine. Some of the common side effects you may experience are:

  • Blistering
  • Discoloration of skin
  • Swelling

Some adverse side effects include:

  • Blurred or loss of vision
  • Chest pain
  • Dizziness

If you experience any of these symptoms, please call your doctor immediately.

Please check the patient information sheet supplied with your medication for a more detailed list of possible side effects. If any side effects disclosed concern you, seek reassurance from your doctor or the team at myaware for more information.

Known UK suppliers

AAH Pharmaceuticals Ltd, Advanz Pharma, Martindale Pharmaceuticals Ltd


There is limited data on the effect of neostigmine on pregnancy and breast feeding. Please consult your doctor whether to continue taking Neostigmine and whether the benefit outweighs the risk.

Report any side effect you have to the Medicines Health and Regulatory Authority (MHRA) as part of their Yellow Card Scheme.

Click here to report a side effect to the MHRA.