Pharmacology · Class
Neuromuscular block reversal agents !
Drugs that restore muscle strength at the end of surgery after a non-depolarising blocker: sugammadex and neostigmine.
Updated 2026-11-01
What they are
Two strategies: acetylcholinesterase inhibitors (neostigmine) raise acetylcholine at the end plate so it wins the competition; sugammadex, a cyclodextrin, encapsulates rocuronium or vecuronium in plasma and pulls it away from the neuromuscular junction.
Mechanism of action
Neostigmine inhibits acetylcholinesterase: acetylcholine builds up and displaces the competitive blocker; because it also stimulates muscarinic receptors, it is given with atropine or glycopyrronium. Sugammadex forms a very stable complex with rocuronium or vecuronium; their free concentration falls and the blocker leaves the end plate down its gradient.
Target: Acetylcholinesterase (neostigmine); free rocuronium and vecuronium (sugammadex)
Drugs in this class
Others in the class
- Neostigmine
- Edrophonium
- Glycopyrronium (paired with neostigmine)
Test yourself
Think of the answer, then tap the question to see it.
Why is glycopyrronium or atropine given with neostigmine?
To block the muscarinic effects of the accumulated acetylcholine, above all bradycardia, salivation and bronchospasm.
Which blockers does sugammadex reverse?
The aminosteroids rocuronium and vecuronium, which it encapsulates; it has no effect on suxamethonium, atracurium or cisatracurium.
What should a patient using hormonal contraception know after receiving sugammadex?
That sugammadex can bind the progestogen: it counts as a missed dose, and an additional non-hormonal method is needed for 7 days.
Educational content on how drugs work; not a prescribing guide and no substitute for a health professional's advice. No doses are given.
Sources: DailyMed - SUGAMMADEX injection, solution (DailyMed (U.S. National Library of Medicine), 2026); DailyMed - NEOSTIGMINE METHYLSULFATE injection (DailyMed (U.S. National Library of Medicine), 2026); Goodman & Gilman's The Pharmacological Basis of Therapeutics, 14th ed., ch. 13 (McGraw Hill, 2023).
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Representative model, for educational purposes only.