Neostigmine is not an antagonist of rocuronium because it does not compete with rocuronium for the muscle end-plate receptor site. Neostigmine inhibits acetylcholinesterase, which allows acetylcholine to compete effectively with rocuronium and other nondepolarizing muscle relaxants for the receptor, leading to a recovery of muscle tone. Therefore, its effect is at least a partial form of indirect antagonism.
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