Drug interactions
Metoprolol + Neostigmine
Severity: Moderate
Metoprolol 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 enhances vagal tone through cholinesterase inhibition and can cause bradycardia, which may be worsened by beta-blockade. Severe bradycardia or AV block is possible, especially when neostigmine is used for reversal of neuromuscular block.
What this interaction means in plain words
Metoprolol 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.
Metoprolol belongs to Cardiovascular; Neostigmine belongs to Central Nervous System.
Why it happens
Additive heart rate slowing from cholinergic stimulation plus beta-1 receptor blockade.
What to do
Monitor ECG and heart rate when neostigmine is given to patients taking metoprolol, and give an anticholinergic such as glycopyrrolate as appropriate.
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 Metoprolol
- Metoprolol + Thioridazine Contraindicated
- Amifostine + Metoprolol Major
- Amiodarone + Metoprolol Major
- Atenolol-chlorthalidone + Metoprolol Major
- Atenolol + Metoprolol Major
- Betaxolol + Metoprolol Major
Other interactions of Neostigmine
Frequently asked questions
Can I take Metoprolol with Neostigmine?
MediHelp rates the interaction as moderate. Metoprolol 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 enhances vagal tone through cholinesterase inhibition and can cause bradycardia, which may be worsened by beta-blockade. Severe bradycardia or AV block is possible, especially when neostigmine is used for reversal of neuromuscular block.
How serious is the interaction between Metoprolol 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 when neostigmine is given to patients taking metoprolol, and give an anticholinergic such as glycopyrrolate as appropriate.
What other medicines interact with Metoprolol?
MediHelp also lists interactions of Metoprolol with, for example, Thioridazine, Amifostine, Amiodarone. The full list is on the Metoprolol page.
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