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Neostigmine + glycopyrrolate is a fixed-dose intravenous combination used to reverse the effects of non-depolarizing neuromuscular blocking agents (NMBAs) after surgery. Neostigmine is a competitive acetylcholinesterase inhibitor that increases acetylcholine levels at the neuromuscular junction, thereby antagonizing the action of NMBAs and restoring muscle function. Glycopyrrolate is an anticholinergic (antimuscarinic) agent included to counteract muscarinic side effects of increased acetylcholine, such as bradycardia and excessive secretions, by inhibiting acetylcholine action on smooth muscle, cardiac tissue, exocrine glands, and other autonomic effector cells[1][4][5][6]. The combination is approved for use in adults and children at least 2 years old following surgical procedures requiring NMBA reversal.
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