neostigmine + glycopyrrolate (Henry Ford Health)

Neostigmine + glycopyrrolate is a combination pharmacological reversal strategy used to counteract the effects of non-depolarizing neuromuscular blocking agents (NMBAs) following surgical procedures. Neostigmine, an acetylcholinesterase inhibitor, works by preventing the breakdown of acetylcholine, thereby increasing its concentration at the neuromuscular junction to outcompete NMBAs for nicotinic receptors. Glycopyrrolate, a synthetic quaternary ammonium antimuscarinic agent, is co-administered to mitigate the systemic parasympathetic side effects of neostigmine, such as bradycardia, excessive salivation, and bronchoconstriction. This combination is a standard of care in anesthesia and is being evaluated by the Henry Ford Health System in a Phase 4 clinical trial (NCT03824301) to determine if its use expedites time to extubation in fast-track cardiac surgery patients compared to sugammadex or no reversal.

Brand names

Robinul-Neostigmine

Other names

neostigmine/glycopyrrolateneostigmine methylsulfate and glycopyrrolate