Drug interactions
Esmolol + Neostigmine
Severity: Moderate
Esmolol and Neostigmine: moderate interaction.
Last updated
For healthcare professionals — reference only. This page is a brief summary, not medical advice and not a substitute for official labeling or clinical judgement. Always verify before prescribing or dispensing.
Summary
Neostigmine increases vagal activity and can cause bradycardia, which may be additive with esmolol. Severe bradycardia or AV block is possible, particularly during anesthesia reversal.
What this interaction means in plain words
Esmolol and Neostigmine can affect each other. The combination is often manageable, but it may need a change of dose, a change of timing, or extra checks while both are taken.
Esmolol belongs to Cardiovascular; Neostigmine belongs to Central Nervous System.
Why it happens
Additive heart rate slowing from cholinesterase inhibition and beta-1 blockade.
What to do
Monitor ECG and heart rate during neostigmine administration and have an anticholinergic available.
What to ask your pharmacist
- Should I take them at different times of day?
- Does the dose of either medicine need to change?
- Is there anything I should avoid, such as alcohol or certain foods, while on both?
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Other interactions of Esmolol
- Acebutolol + Esmolol Major
- Amifostine + Esmolol Major
- Amiodarone + Esmolol Major
- Celiprolol + Esmolol Major
- Diltiazem + Esmolol Major
- Epinephrine racemic + Esmolol Major
Other interactions of Neostigmine
Frequently asked questions
Can I take Esmolol with Neostigmine?
MediHelp rates the interaction as moderate. Esmolol and Neostigmine can affect each other. The combination is often manageable, but it may need a change of dose, a change of timing, or extra checks while both are taken. Neostigmine increases vagal activity and can cause bradycardia, which may be additive with esmolol. Severe bradycardia or AV block is possible, particularly during anesthesia reversal.
How serious is the interaction between Esmolol and Neostigmine?
MediHelp rates it moderate, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Monitor ECG and heart rate during neostigmine administration and have an anticholinergic available.
What other medicines interact with Esmolol?
MediHelp also lists interactions of Esmolol with, for example, Acebutolol, Amifostine, Amiodarone. The full list is on the Esmolol page.
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