- Examples: Neostigmine and Pyridostigmine
- Neostigmine can be used reversal of neuromuscular blockade (sugammadex is used for rocuronium or vecuronium)
- Give simultaneously with anticholinergic agent, such as atropine or glycopyrronium, to prevent muscarinic effects (especially bradycardia)
- Used in myasthenia gravis as well