Tilstigmin

Neostigmine is a synthetic, water-soluble quaternary ammonium compound that functions as a reversible acetylcholinesterase inhibitor, primarily used to reverse the effects of non-depolarizing neuromuscular blocking agents after surgery and in the diagnosis and symptomatic treatment of myasthenia gravis.[1][2] It is administered via intravenous, intramuscular, oral, or subcutaneous routes, with typical dosing for neuromuscular reversal ranging from 0.03 to 0.07 mg/kg intravenously, often in combination with an antimuscarinic agent like glycopyrrolate to mitigate cholinergic side effects.[2] Originally synthesized in the 1930s, neostigmine has become a cornerstone in anesthesiology and neurology due to its ability to enhance cholinergic transmission without crossing the blood-brain barrier.[2]