Neostigmine (prostigmine), a synthetic drug, was first used in the form of the methylsulfate for stimulating the intestinal tract and thus, overcoming postoperative atony. A second and even more striking clinical application was soon discovered, based on its effect on the symptoms of myasthenia gravis. Even when the drug is given by mouth as neostigmine bromide, the decrease in muscle fatigue is often striking. Moreover, neostigmine will apparently inhibit cholinesterase, the chemical agent that destroys acetylcholine, an important factor in neuromuscular transmissions. Acetylcholine is found in nerve tissue and at the myoneural junction. One theory accounts for the effectiveness of neostigmine in myasthenia gravis on the assumption that inhibition of the cholinesterase at the junction permits an impulse to pass more readily and effectively from the nerve to the muscle. Not all investigators accept this explanation, but none disagree with regard to the powerful effect of the drug when given
NEOSTIGMINE AND NEUROMUSCULAR DYSFUNCTION. JAMA. 1945;128(11):812–813. doi:10.1001/jama.1945.02860280038010
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