How does Prevduo (neostigmine / glycopyrrolate) work?

Prevduo (neostigmine / glycopyrrolate) is a combination of two medications, __neostigmine__ and __glycopyrrolate__. During surgery, [non-depolarizing neuromuscular blockers (NMBAs)](https://www.ncbi.nlm.nih.gov/books/NBK534828/) are used to block a chemical called [acetylcholine](https://www.ncbi.nlm.nih.gov/books/NBK557825/) in your body. This leads to temporary muscle paralysis, which is important for a successful surgery. __Neostigmine__ is an [acetylcholinesterase inhibitor](https://www.goodrx.com/classes/cholinesterase-inhibitors) that raises the levels of acetylcholine to reverse the paralyzing effects of NMBAs. But raising the levels of acetylcholine can also cause side effects in [many other parts of your body](https://www.ncbi.nlm.nih.gov/books/NBK557825/#:~:text=Acetylcholine%20intervenes%20in%20numerous%20physiological,acetylcholine%20is%20an%20excitatory%20mediator.), like low heart rate or excessive body secretions. So __glycopyrrolate__ is used to block the effects of acetylcholine in the rest of your body to prevent side effects from neostigmine.

How much Prevduo (neostigmine / glycopyrrolate) will I receive?

The dose of Prevduo (neostigmine / glycopyrrolate) is different for everyone. It depends on why you need the medication, your age, and your weight. Your provider will also change your dose based on a [nerve stimulation test](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5247382/). It tests how deeply your muscles are paralyzed by sending a small electric shock to your nerve to see if your muscle twitches.

What are the common side effects of Prevduo (neostigmine / glycopyrrolate)?

Possible side effects from the [neostigmine](https://www.ncbi.nlm.nih.gov/books/NBK470596/#article-25690.s5) portion of Prevduo (neostigmine / glycopyrrolate) include low heart rate or blood pressure, difficulty sleeping, and itching. But the glycopyrrolate in Prevduo (neostigmine / glycopyrrolate) should help prevent or lessen these side effects. Side effects from [glycopyrrolate](https://www.ncbi.nlm.nih.gov/books/NBK526035/#article-35868.s5) in Prevduo (neostigmine / glycopyrrolate) include blurry vision, dry skin, dry mouth, and dizziness.

Prevduo

neostigmine / glycopyrrolate

Used for Post-Surgical Care

Prevduo (neostigmine / glycopyrrolate) is a medication that's given intravenously (into the vein) to people in the hospital after undergoing surgery. Specifically, it's used for those who have received certain medications that temporarily paralyze their muscles during surgery. Prevduo is currently the only FDA-approved product containing two medications together: neostigmine and glycopyrrolate. Some side effects to look out for include drowsiness, blurred vision, and diarrhea.

Reviewed by:

Robert Chad Hakim, PharmD, BCCCP

Daisy Chau, PharmD

Last reviewed on June 27, 2023

What is Prevduo (neostigmine / glycopyrrolate)?

What is Prevduo (neostigmine / glycopyrrolate) used for?

Reverse the effects of certain muscle-paralyzing effects after surgery in adults and children age 2 years and older

Are you looking for information on neostigmine (Bloxiverz) or glycopyrrolate (Robinul) instead?

Drug facts

Common Brands	Prevduo
Drug Class	Acetylcholinesterase inhibitor / Anticholinergic
Controlled Substance Classification	Not a controlled medication
Generic Status	No lower-cost generic available
Availability	Prescription only

Common Brands

Prevduo

Drug Class

Acetylcholinesterase inhibitor / Anticholinergic

Controlled Substance Classification

Not a controlled medication

Generic Status

No lower-cost generic available

Availability

Prescription only

Common questions about Prevduo

During major surgery, it's common to receive non-depolarizing neuromuscular blockers (NMBAs) to temporarily paralyze your muscles. After the surgery, you might be given Prevduo to reverse the effects of the NMBA. [[EDITOR|DRUGDISPLAYNAME]] contains two components: neostigmine, which reverses the paralysis, and glycopyrrolate, which helps prevent certain side effects caused by neostigmine, such as low heart rate and excessive body secretions.

Prevduo is a combination of two medications, neostigmine and glycopyrrolate. During surgery, non-depolarizing neuromuscular blockers (NMBAs) are used to block a chemical called acetylcholine in your body. This leads to temporary muscle paralysis, which is important for a successful surgery. Neostigmine is an acetylcholinesterase inhibitor that raises the levels of acetylcholine to reverse the paralyzing effects of NMBAs. But raising the levels of acetylcholine can also cause side effects in many other parts of your body, like low heart rate or excessive body secretions. So glycopyrrolate is used to block the effects of acetylcholine in the rest of your body to prevent side effects from neostigmine.

Prevduo is given by a trained healthcare provider as a quick injection through the veins (intravenously, IV) over one minute. You won't feel the Prevduo being given to you because you'll still be asleep from the surgery.

The dose of Prevduo is different for everyone. It depends on why you need the medication, your age, and your weight. Your provider will also change your dose based on a nerve stimulation test. It tests how deeply your muscles are paralyzed by sending a small electric shock to your nerve to see if your muscle twitches.

Possible side effects from the neostigmine portion of Prevduo include low heart rate or blood pressure, difficulty sleeping, and itching. But the glycopyrrolate in Prevduo should help prevent or lessen these side effects. Side effects from glycopyrrolate in Prevduo include blurry vision, dry skin, dry mouth, and dizziness.

Prevduo (neostigmine / glycopyrrolate) dosage

Typical dosage for Prevduo (neostigmine / glycopyrrolate)

References

Bouju, P., et al. (2017). Clinical assessment and train-of-four measurements in critically ill patients treated with recommended doses of cisatracurium or atracurium for neuromuscular blockade: A prospective descriptive study. Annals of Intensive Care.

Clar, D. T., et al. (2023). Nondepolarizing neuromuscular blockers. StatPearls.

Endo International plc. (2023). Endo launches Prevduo™ (neostigmine methylsulfate and glycopyrrolate injection), the first and only FDA-approved neostigmine-glycopyrrolate combination pre-filled syringe. PRNewswire.

GoodRx Health has strict sourcing policies and relies on primary sources such as medical organizations, governmental agencies, academic institutions, and peer-reviewed scientific journals. Learn more about how we ensure our content is accurate, thorough, and unbiased by reading our editorial guidelines.

What is Prevduo (neostigmine / glycopyrrolate)?

What is Prevduo (neostigmine / glycopyrrolate) used for?

Are you looking for information on neostigmine (Bloxiverz) or glycopyrrolate (Robinul) instead?

Drug facts

Common questions about Prevduo

What is Prevduo used for?

How does Prevduo work?

How is Prevduo given?

How much Prevduo will I receive?

What are the common side effects of Prevduo?

Prevduo (neostigmine / glycopyrrolate) dosage

Typical dosage for Prevduo (neostigmine / glycopyrrolate)

References

View All References (4)

Common questions about Prevduo

What is Prevduo used for?

How does Prevduo work?

How is Prevduo given?

How much Prevduo will I receive?

What are the common side effects of Prevduo?