Drug & supplement interaction

Clubmoss + Neostigmine Methylsulfate

Neostigmine Methylsulfate brand name: Bloxiverz.

Moderate Interaction
Medically reviewed by · Updated September 2026
The bottom line Moderate

Neostigmine Methylsulfate falls into 2 drug categories that Clubmoss can interact with; the most serious is rated moderate. Evidence from in vitro research suggests that clubmoss extract can inhibit acetylcholinesterase activity.

Read the full interaction report
SeverityModerate
LikelihoodPossible
Interactions2
EvidenceD
What do Severity, Likelihood & Evidence mean?
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Interaction report

Clubmoss and Neostigmine Methylsulfate

These two interact in 2 distinct ways. Each one is explained separately below.

Why Are There 2 Interactions?

Clubmoss interacts with whole categories of medication. Neostigmine Methylsulfate falls into 2 of those categories, so it can interact with Clubmoss in 2 different ways. We’ve listed each one below — your overall risk is driven by the most serious of them (Moderate).

Moderate

ACETYLCHOLINESTERASE (AChE) INHIBITORS

1 of 2

Why this applies to Neostigmine Methylsulfate

Neostigmine Methylsulfate falls under ACETYLCHOLINESTERASE (AChE) INHIBITORS — the group Clubmoss interacts with.

Evidence from in vitro research suggests that clubmoss extract can inhibit acetylcholinesterase activity. Theoretically, concurrent use of clubmoss with other acetylcholinesterase (AChE) inhibitors might have additive effects and increase the risk of cholinergic side effects. AChE inhibitors and cholinergic drugs include bethanechol (Urecholine), donepezil (Aricept), echothiophate (Phospholine Iodide), edrophonium (Enlon, Reversol, Tensilon), neostigmine (Prostigmin), physostigmine (Antilirium), pyridostigmine (Mestinon, Regonol), succinylcholine (Anectine, Quelicin), and tacrine (Cognex).
Severity Moderate Likelihood Possible Evidence D

Interaction has been documented in animal or in lab research, or the interaction has been documented in humans but is limited to case reports or conflicting clinical research exists.

Dr. Brian Staiger, PharmD, BCPS
Dr. Brian Staiger explains PharmD, Clinical Pharmacist

Here's the gist: neostigmine works by blocking an enzyme called acetylcholinesterase, which lets the chemical messenger acetylcholine build up and get nerves and muscles firing again. Lab studies suggest clubmoss may block that same enzyme. So in theory, taking them together could pile one effect on top of another and push you toward too much cholinergic activity.

If that happened, you might notice things like extra saliva or watery eyes, nausea, belly cramping, diarrhea, slow heartbeat, muscle twitching, or sweating. I'll be honest, this concern comes only from test-tube research, not real patients, so it's far from proven. Still, since clubmoss carries its own toxic alkaloids, I'd run it by your doctor or pharmacist before combining the two.

Contact Dr. Brian directly if you have additional questions on this interaction
References
  1. Orhan, I., Terzioglu, S., and Sener, B. Alpha-onocerin: an acetylcholinesterase inhibitor from Lycopodium clavatum. Planta Med. 2003;69(3):265-267.
Moderate

CHOLINERGIC DRUGS

2 of 2

Neostigmine Methylsulfate also falls under CHOLINERGIC DRUGS.

Evidence from in vitro research suggests that clubmoss extract can inhibit acetylcholinesterase activity. Theoretically, concurrent use of clubmoss with other cholinergic drugs might have additive effects and increase the risk of cholinergic side effects. AChE inhibitors and cholinergic drugs include bethanechol (Urecholine), donepezil (Aricept), echothiophate (Phospholine Iodide), edrophonium (Enlon, Reversol, Tensilon), neostigmine (Prostigmin), physostigmine (Antilirium), pyridostigmine (Mestinon, Regonol), succinylcholine (Anectine, Quelicin), and tacrine (Cognex).
Severity Moderate Likelihood Possible Evidence D

Interaction has been documented in animal or in lab research, or the interaction has been documented in humans but is limited to case reports or conflicting clinical research exists.

Dr. Brian Staiger, PharmD, BCPS
Dr. Brian Staiger explains PharmD, Clinical Pharmacist

Here's the basic idea with these two together. Neostigmine works by blocking an enzyme called acetylcholinesterase, which lets the chemical messenger acetylcholine build up and boosts nerve and muscle signaling. Lab studies (test-tube only, not people) hint that clubmoss may block that same enzyme. So in theory, pairing them could stack their effects and push you toward too much cholinergic activity.

What might that look like? Things like extra saliva and tearing, watery eyes, belly cramps, nausea or diarrhea, a slow heartbeat, sweating, and muscle twitching. I want to be honest though, this is based only on early lab research, so the real-world risk is uncertain. Since clubmoss also carries its own toxic alkaloids, please check with your doctor or pharmacist before combining them.

Contact Dr. Brian directly if you have additional questions on this interaction
References
  1. Orhan, I., Terzioglu, S., and Sener, B. Alpha-onocerin: an acetylcholinesterase inhibitor from Lycopodium clavatum. Planta Med. 2003;69(3):265-267.

What These Ratings Mean

Every interaction above is graded three ways — here’s the key to each label.

Severity how clinically significant the interaction is
Major

Clinically significant. Avoid the combination, or use only under close professional supervision.

Moderate

Usually worth avoiding or managing — may need monitoring, a dose change, or timing apart.

Minor

Generally not serious. Be aware of it and mention it to your pharmacist.

Likelihood how strong the evidence is that the interaction actually happens in people
  • LikelyWell-controlled human studies have demonstrated the likely existence of this interaction.
  • ProbableInteraction has not been documented in well-controlled studies, however, the interaction has been demonstrated in some small human studies or in controlled animal studies in conjunction with multiple case reports.
  • PossibleInteraction has been documented in animal or in lab research, or the interaction has been documented in humans but is limited to case reports or conflicting clinical research exists.
  • UnlikelyInteraction has been demonstrated in animal or in lab research but has been shown not to occur in humans.
Evidence the quality of the studies behind the rating (graded A–D)
  • AHigh-quality meta-analysis (quantitative systematic review).
  • BCase-control study.
  • CConsensus.
  • DAnecdotal evidence.

These ratings are for information only. Never start, stop, or otherwise change your therapy before speaking with your provider.

Keep it in perspective

Clubmoss Also Interacts With Other Medications

Clubmoss has 218 moderate known drug interactions in our database — the Neostigmine Methylsulfate one above is among them. If you take anything else, check it against the full list below.

Moderate 218 No known interaction 2,612 (incl. Neostigmine Methylsulfate)
Taking anything else?

Check Another of Your Medications Against Clubmoss

Covers the 2,830 medications we’ve checked against Clubmoss. Pick one to open its full report.

Everything else you take

See Every Supplement That Interacts With Neostigmine Methylsulfate

This page covers Clubmoss only. If you take other supplements — a multivitamin, a sleep aid, something for joints — the Neostigmine Methylsulfate page lists 22 supplements it has a documented interaction with, worst first, each one explained.

The most serious there right now: Arenaria Rubra (moderate), Bacopa (moderate), Bael (moderate), Betel Nut (moderate) and Boxwood (moderate).

By severity: 21 moderate · 1 minor.

From our pharmacist’s overview on the Neostigmine Methylsulfate page

“Betel nut sits at the top of my concerns for anyone on neostigmine (Bloxiverz), a medication that boosts acetylcholine to strengthen nerve-to-muscle signaling. Nearly all 22 supplements on file work the same way the drug does, blocking the enzyme that clears acetylcholine, so stacking them can pile on cholinergic side effects like cram…”

Reviewed by 2 · Jul 18, 2026

Open the Neostigmine Methylsulfate interaction page

How much people look this up

Where Clubmoss and Neostigmine Methylsulfate Sit Against Everything Else

Out of every supplement and medication people look up on HelloPharmacist, here is where these two land this week — and which way each has been moving.

Supplement Clubmoss
Top half

#631 of 1,452 supplements looked up here in the last 7 days

29 days ago today
Medication Neostigmine Methylsulfate
Steady interest

#2,605 of 2,830 medications looked up here in the last 7 days

29 days ago today

Position among everything looked up on this site, not a measure of how commonly either one is used or how important it is. A supplement can climb this list because of a news story. It counts every request to the page, automated ones included, and nothing here identifies anyone.

Supplement

About Clubmoss

What is Clubmoss?

Clubmoss
  • Bladder and kidney complaints
  • Digestive upset
  • Skin irritation and chafing
  • Respiratory problems
  • Used in homeopathy

Clubmoss (Lycopodium clavatum) is a primitive plant with a long history in folk medicine and homeopathy, but there is very little reliable human research to show it works for any health condition. It contains potentially toxic alkaloids, so it should be used with great caution, and people who are pregnant or breastfeeding should avoid it. Talk with a pharmacist or doctor before trying it.

Read the full Clubmoss monograph & all interactions
Keep checking

Other Drugs & Clubmoss

Browse every other medication we’ve checked against Clubmoss — both the ones with a known interaction and the ones without. Select any drug for the full detail.

0Major
218Moderate
0Minor
2,611No known interaction
218 Moderate 2,611 No interaction
Moderate

218 interactions

Showing 60 of 218 moderate interactions — see all 218 on the Clubmoss page.

No interaction 2,611 drugs checked — show the list

We also checked Clubmoss against these medications and found no known interaction in our sources. Open any page to confirm.

Showing the 60 most looked-up of 2,611 medications checked with no known interaction — see the full Clubmoss list.

See the full Clubmoss interactions page
See every supplement checked against Neostigmine Methylsulfate, ranked by severity
Sources

Sources & How We Checked

Interaction details are evidence-graded and sourced from the Natural Medicines database. The medication overview comes from MedlinePlus.

Content is written and reviewed by licensed HelloPharmacist pharmacists. See our data sources and editorial standards for how this information is built and checked.

Parts of this content are provided by the Therapeutic Research Center, LLC.

DISCLAIMER: Currently this does not check for drug-drug interactions. This is not an all-inclusive comprehensive list of potential interactions and is for informational purposes only. Not all interactions are known or well-reported in the scientific literature, and new interactions are continually being reported. Input is needed from a qualified healthcare provider including a pharmacist before starting any therapy. Application of clinical judgment is necessary.

© 2021 Therapeutic Research Center, LLC

Keep exploring
Clubmoss monograph › Uses, safety, and every drug interaction in one place Neostigmine Methylsulfate supplement interactions › Every supplement checked against Neostigmine Methylsulfate, ranked by severity Supplement interaction checker › Check any supplement or product against your medications Browse medications A–Z › Every drug we've checked against herbs & supplements Ask a pharmacist › Free, personal answer from our licensed team
Pharmacist Counseling Corner

Taking Clubmoss and Neostigmine Methylsulfate Together: Common Questions

Can you take Clubmoss with Neostigmine Methylsulfate?
There is a moderate interaction, so it may be acceptable with monitoring or timing changes — but check with your pharmacist first. Read the full details on this page and confirm with your pharmacist before combining them.
Why are there 2 interactions listed for Clubmoss and Neostigmine Methylsulfate?
Neostigmine Methylsulfate belongs to more than one drug category, and Clubmoss interacts with each of those categories a little differently. We list every one so nothing is missed — your overall risk is driven by the most serious of them.
How serious is the Clubmoss and Neostigmine Methylsulfate interaction?
We rate it Moderate. This combination may require monitoring, a dose adjustment, or separating the times you take each one. Consult your pharmacist before using them together.

Written and reviewed by the HelloPharmacist editorial staff. Our editorial policy

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This information is for education only and is not a substitute for professional medical advice. Always check with your pharmacist or doctor before starting, stopping, or combining supplements and medications.