Prostigmin, Bloxiverz, and Other Names: What Is Another Name for Neostigmine?

October 12, 2025 •

5 min read

Neostigmine, a medication used since the 1930s to treat neuromuscular conditions, is commonly known by its brand name Prostigmin. Understanding what is another name for neostigmine is crucial, as the drug may be prescribed under different brand names or as a generic, depending on its formulation and clinical use. This article explores the various names and properties of this important drug.

Quick Summary

Neostigmine is an acetylcholinesterase inhibitor known by brand names like Prostigmin and Bloxiverz. It is used to treat myasthenia gravis and to reverse the effects of certain muscle relaxants after surgery.

Key Points

Multiple Brand Names: The generic medication neostigmine is known by several brand names, including Prostigmin and Bloxiverz.
Inhibition Mechanism: Neostigmine works by inhibiting the enzyme acetylcholinesterase, which increases the amount of acetylcholine available at neuromuscular junctions.
Treatment for Myasthenia Gravis: Neostigmine improves muscle strength in patients with myasthenia gravis, though the longer-acting pyridostigmine is often preferred for long-term management.
Surgical Application: The injectable form of neostigmine is commonly used in anesthesia to reverse the effects of muscle-relaxing agents after surgery.
Risk of Cholinergic Crisis: Excessive doses of neostigmine can lead to a dangerous overdose called cholinergic crisis, characterized by severe muscle weakness.
Pharmacokinetic Differences: The onset and duration of action for neostigmine vary depending on whether it is administered orally or parenterally.
Management of Side Effects: To mitigate common side effects like bradycardia associated with neostigmine injections, an anticholinergic agent like glycopyrrolate is often administered concurrently.

The generic name neostigmine refers to a medication that functions as an acetylcholinesterase inhibitor, a class of drugs that prevent the breakdown of the neurotransmitter acetylcholine. This action increases the availability of acetylcholine at the neuromuscular junction, which is beneficial for certain medical conditions. While neostigmine is the official generic name, patients and healthcare providers may encounter it under several trade names or as different salt forms, leading to some confusion.

Brand and Generic Identifiers for Neostigmine

Identifying neostigmine can be complex due to its various names and salt forms. The most prominent brand names associated with neostigmine include Prostigmin and Bloxiverz, although different formulations and marketing can affect which name is used.

Prostigmin: This is a classic and widely recognized brand name for neostigmine. Historically, it was used for both oral tablets (neostigmine bromide) and injectable forms (neostigmine methylsulfate). However, the Prostigmin brand has been discontinued in the U.S., though generic equivalents remain available.
Bloxiverz: This is another brand name for neostigmine methylsulfate injection, specifically used in hospital and clinical settings to reverse the effects of non-depolarizing neuromuscular blocking agents following surgery.
Generic Neostigmine: The generic versions are most often labeled as “neostigmine bromide” (oral) or “neostigmine methylsulfate” (injectable). Many different manufacturers produce and market these generic products, which is why a patient may see slightly different packaging or vials depending on where they receive their medication.

The Mechanism of Action: How Neostigmine Works

Neostigmine's primary role as a cholinesterase inhibitor is to boost the levels of acetylcholine in the body. The mechanism is as follows:

Acetylcholine Breakdown: The enzyme acetylcholinesterase is naturally present in the body and is responsible for breaking down acetylcholine, a crucial neurotransmitter involved in muscle contraction.
Enzyme Inhibition: Neostigmine binds to and inhibits acetylcholinesterase, preventing it from carrying out its function.
Increased Acetylcholine: With the breakdown process halted, acetylcholine levels increase at the synaptic cleft—the space between nerve and muscle cells.
Enhanced Muscle Contraction: The higher concentration of acetylcholine can better stimulate the receptors on the muscle cells, leading to improved muscle strength and function, particularly in conditions where nerve-muscle communication is impaired.

Neostigmine primarily acts on the peripheral nervous system, as its quaternary ammonium structure prevents it from crossing the blood-brain barrier. This is in contrast to other cholinesterase inhibitors, like physostigmine, which can affect the central nervous system.

Common Medical Uses for Neostigmine

Neostigmine is used for several key medical applications, primarily involving the nervous and muscular systems. The specific formulation (oral vs. injectable) and dosage depend on the medical condition being treated.

Myasthenia Gravis: For patients suffering from myasthenia gravis, an autoimmune disease that causes fluctuating muscle weakness, neostigmine is used to improve muscle strength. Oral tablets were traditionally used for this purpose, though the longer-acting pyridostigmine is now often preferred for long-term management due to its better side effect profile.
Reversal of Neuromuscular Blockade: Neostigmine is a critical tool for anesthesiologists and other medical professionals to reverse the effects of non-depolarizing neuromuscular blocking agents used during surgery. This helps patients regain muscle control after procedures requiring temporary muscle paralysis.
Postoperative Urinary Retention and Abdominal Distention: In some cases, neostigmine injection is used to treat or prevent urinary retention or abdominal swelling that can occur after surgery. It stimulates muscle contraction in the bladder and intestines to restore normal function.

Neostigmine vs. Pyridostigmine: A Comparison

Both neostigmine and pyridostigmine are cholinesterase inhibitors used in myasthenia gravis treatment, but they have distinct differences in their pharmacological profiles that influence their clinical applications.


Feature	Neostigmine	Pyridostigmine	Importance in Therapy
Onset of Action	Faster (intravenous is very rapid)	Slower (approximately 45 minutes for oral)	Neostigmine is useful for acute symptom flares or post-surgical reversal.
Duration of Action	Shorter (oral half-life around 52 minutes)	Longer (oral effect lasts 3-4 hours)	Pyridostigmine is generally preferred for chronic, long-term management of myasthenia gravis symptoms due to its longer effect.
Potency	Higher (about four times more potent)	Lower (easier to titrate dose)	Lower potency can be an advantage for achieving symptom control with fewer dose-related adverse effects.
Side Effect Profile	More severe muscarinic side effects, such as increased salivation and GI issues	Milder adverse effect profile	Better tolerability is a major reason pyridostigmine is preferred for chronic use.
Primary Use	Primarily parenteral for post-surgical reversal, or short-term oral therapy	Long-term oral therapy for myasthenia gravis management	Clinical choice depends on the urgency and duration of the required treatment.

Administration and Dosage

Neostigmine is available in both oral (as neostigmine bromide) and injectable (as neostigmine methylsulfate) forms. The method of administration is based on the condition being treated:

Oral Administration: Neostigmine tablets are taken by mouth, with or without food, as directed by a healthcare provider. Dosage is highly individualized and is adjusted based on the patient's symptoms and response. For myasthenia gravis, timing the dosage to coincide with the most physically demanding parts of the day is often important for controlling symptoms.
Parenteral Administration: The injectable form is administered intravenously, intramuscularly, or subcutaneously, typically in a hospital setting. This route is primarily used for post-surgical reversal of muscle relaxants and for acute myasthenic crises.

Side Effects and Safety Considerations

As with any medication, neostigmine is associated with potential side effects. These are largely due to the exaggerated cholinergic effects caused by increased acetylcholine levels.

Common Side Effects

Gastrointestinal distress, including nausea, vomiting, diarrhea, and abdominal cramps.
Increased salivation and sweating.
Increased urination frequency.
Muscle twitching or cramps.
Headache or dizziness.

Serious Side Effects

Bradycardia: A dangerously slow heart rate can occur, especially with the injectable form. Patients with pre-existing heart conditions are at increased risk. An anticholinergic drug, such as atropine or glycopyrrolate, is often co-administered to counteract this effect.
Bronchospasm: Increased bronchial secretions and bronchospasm can occur, posing a risk to patients with asthma or other respiratory conditions.
Cholinergic Crisis: An overdose of neostigmine can lead to a cholinergic crisis, characterized by extreme muscle weakness, excessive salivation, and potential respiratory arrest. This condition requires immediate medical attention and is treated by withdrawing all cholinesterase inhibitors.

Conclusion

While the term neostigmine is the universally recognized generic name, it is also known by several brand names, most notably Prostigmin and Bloxiverz. Despite the discontinuation of the Prostigmin brand in some regions, the generic version and other brands like Bloxiverz remain essential medications for treating myasthenia gravis and for reversing muscle relaxation after surgical procedures. Its effectiveness hinges on its role as a reversible cholinesterase inhibitor, which boosts acetylcholine levels to facilitate muscle contraction. For clinicians and patients alike, understanding the different names and specific applications is vital for safe and effective treatment. Always consult a healthcare professional with any questions regarding neostigmine or other medications.

For more detailed prescribing information and FDA alerts related to neostigmine, you can visit the Drugs.com entry on Prostigmin.

Frequently Asked Questions

Yes, neostigmine is the generic name for the brand-name drug Prostigmin. While the Prostigmin brand has been discontinued in some regions, generic versions are still available.

Bloxiverz is a brand name for neostigmine methylsulfate, an injectable form of the drug typically used in hospitals to reverse the effects of muscle relaxants after surgery.

Neostigmine works as a cholinesterase inhibitor, preventing the enzyme acetylcholinesterase from breaking down acetylcholine. This increases the amount of acetylcholine available to stimulate muscle receptors, thereby improving muscle strength.

Yes, neostigmine bromide is the form used for oral tablets, while neostigmine methylsulfate is the form used for injectable solutions. There are differences in absorption and potency between the oral and parenteral forms.

Neostigmine can cause unwanted muscarinic side effects, such as a slow heart rate (bradycardia) and excessive salivation. An anticholinergic drug, like glycopyrrolate, is often given alongside it to counteract these effects.

While both are cholinesterase inhibitors, pyridostigmine generally has a slower onset and longer duration of action than neostigmine. This makes pyridostigmine more suitable for long-term myasthenia gravis management, while neostigmine is often reserved for acute use or reversal of neuromuscular blockade.

Yes, an overdose can lead to a cholinergic crisis, which causes severe muscle weakness and can affect breathing. This is a medical emergency that requires prompt treatment.