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Neostigmine Side Effects

The most commonly reported side effects of neostigmine include hypotension, cardiac arrest, and drug interaction, based on 1,675 FDA adverse event reports from 2004 to 2025. 6.4% of reports found the drug to be ineffective.

Neostigmine side effects

Percentages show how often each reaction appears relative to total reports for neostigmine.

1
Drug Ineffective6.4%107
2
Hypotension5.3%88
3
Cardiac Arrest5.0%84
4
Drug Interaction5.0%84
5
Bradycardia4.4%73
6
Serotonin Syndrome4.3%72
7
Tachycardia3.6%60
8
Pyrexia3.6%60
9
Nausea3.4%57
10
Off Label Use3.2%53
11
Abdominal Distension2.5%42
12
Pulmonary Oedema2.4%41
13
Dyspnoea2.4%40
14
Respiratory Failure2.4%40
15
White Blood Cell Count Increased2.4%40

These are voluntary reports and do not establish that neostigmine caused these reactions.

Report severity

90.5%Serious1,516 reports
42.9%Hospitalizations718 reports
9.6%Fatal161 reports

Seriousness is determined by the reporter, not by OpenClaim.

Neostigmine drug interactions

Other drugs that appear in adverse event reports alongside neostigmine. Drugs flagged as a suspected cause appear in the first column. Drugs taken at the same time but not suspected appear in the second.

Also suspected

1
Fentanyl19.3%323
2
Propofol16.9%283
3
Glycopyrrolate10.9%182
4
Atropine10.6%178
5
Ondansetron9.0%150
6
Midazolam8.7%146
7
Rocuronium-bromide8.2%137
8
Sevoflurane7.9%132
9
Lidocaine6.0%100
10
Acetaminophen5.1%86
11
Atracurium-besylate4.8%81
12
Ketamine-hydrochloride4.8%81
13
Sufentanil-citrate4.7%78
14
Vecuronium-bromide3.9%66
15
Succinylcholine-chloride3.8%63

Taken alongside

1
Propofol33.4%559
2
Fentanyl27.4%459
3
Glycopyrrolate21.8%365
4
Midazolam21.5%360
5
Acetaminophen19.6%328
6
Rocuronium-bromide19.3%324
7
Ondansetron14.8%248
8
Dexamethasone13.3%222
9
Lidocaine13.2%221
10
Atropine13.1%220
11
Sevoflurane11.7%196
12
Apomorphine-hydrochloride10.0%167
13
Furosemide9.9%166
14
Cefazolin-sodium9.6%161
15
Hydromorphone-hydrochloride9.1%153

Co-occurrence in adverse event reports does not establish a drug interaction. Patients often take multiple medications, and these lists reflect prescribing patterns rather than causal relationships. Consult a healthcare provider about potential drug interactions.

Who reports neostigmine side effects

47.2% of neostigmine adverse event reports involve female patients and 38.4% involve male patients. The largest age group is adult at 65%. These figures reflect who reports side effects, not underlying risk.

Sex

Female47.2%
Male38.4%
Unknown14.4%

Age group

< 22.8%
2–113.6%
12–173.8%
18–6464.5%
65+25.2%

What is neostigmine used for

Conditions and purposes for which patients were taking neostigmine when the adverse event was reported.

Abdominal DistensionAnaesthesiaAnaesthesia ProcedureAnaesthesia ReversalAnorectal ManometryAntibiotic ProphylaxisAnticholinergic SyndromeAsthenopiaAbdominal DistensionAbdominal PainAgitationAmyotrophic Lateral SclerosisAnaesthesiaAnaesthesia ProcedureAnaesthesia Reversal

Showing 15 of 133 indications

Neostigmine brand names and reporting trend

Neostigmine is sold under the brand name Prevduo.

Brand names

Prevduo1,708

Quarterly reports (20042025)

20052010201520202025

An upward trend reflects increased FAERS reporting overall, not necessarily increased risk.

Taking neostigmine with another medication?

Ask OpenClaim about your specific drug combination. Get a sourced report using FDA data, drug labels, and medical literature.