Pyridostigmine

Pyridostigmine Brand Names- Mestinon | Regonol

What is Pyridostigmine

Pyridostigmine is an oral and parenteral cholinesterase inhibitor indicated for the treatment of myasthenia gravis and the reversal of the neuromuscular blocking effects of nondepolarizing muscle relaxants.

It is also indicated for military medical use only as a pretreatment against the lethal effects of Soman nerve agent poisoning in conjunction with protective garments.

Pyridostigmine facilitates the transmission of impulses across the myoneural junction by inhibiting the destruction of acetylcholine by cholinesterase.

Pyridostigmine is an analog of neostigmine but differs from it in certain clinically significant aspects; for example, pyridostigmine has a longer duration of action and is associated with fewer muscarinic effects, such as bradycardia, salivation, and gastrointestinal stimulation.

The evidence for the effectiveness of pyridostigmine as pretreatment against Soman-induced toxicity was derived from animal studies alone.

Indications

  • myasthenia gravis
  • nerve gas exposure prophylaxis
  • neuromuscular blockade reversal

For the treatment of myasthenia gravis

Side Effects

  1. abdominal pain
  2. agitation
  3. alopecia
  4. amblyopia
  5. borborygmi
  6. bronchial secretions
  7. confusion
  8. depression
  9. diaphoresis
  10. diarrhea
  11. drowsiness
  12. dysmenorrhea
  13. epistaxis
  14. fecal incontinence
  15. flatulence
  16. hallucinations
  17. headache
  18. hyperesthesia
  19. hyperhidrosis
  20. hypersalivation
  21. hypertonia
  22. increased urinary frequency
  23. lacrimation
  24. lethargy
  25. miosis
  26. muscle cramps
  27. myalgia
  28. nausea
  29. ocular pain
  30. pallor
  31. phlebitis
  32. rash
  33. restlessness
  34. seizures
  35. syncope
  36. urinary incontinence
  37. vertigo
  38. vomiting
  39. weakness
  40. xerosis

Electrolyte abnormalities, possibly resulting from high serum bromide concentrations, have been reported with pyridostigmine.

Monitoring Parameters

  • laboratory monitoring not necessary
  • neurologic function

Contraindications

  • adrenal insufficiency
  • asthma
  • bladder obstruction
  • bradycardia
  • breast-feeding
  • bromide hypersensitivity
  • cardiac arrhythmias
  • cholinesterase inhibitor toxicity
  • chronic obstructive pulmonary disease (COPD)
  • electrolyte imbalance
  • GI obstruction
  • glaucoma
  • hypertension
  • ileus
  • neonates
  • pregnancy
  • renal disease
  • requires an experienced clinician
  • urinary tract obstruction

Pyridostigmine is contraindicated in patients with known hypersensitivity anticholinesterase agents.

Interactions

  • Ambenonium Chloride
  • Amifampridine
  • Amikacin
  • Aminoglycosides
  • Amitriptyline
  • Amitriptyline; Chlordiazepoxide
  • Amoxapine
  • Articaine; Epinephrine
  • Atracurium
  • Atropine
  • Atropine; Benzoic Acid; Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate
  • Atropine; Difenoxin
  • Atropine; Diphenoxylate
  • Atropine; Edrophonium
  • Atropine; Hyoscyamine; Phenobarbital; Scopolamine
  • Azelastine; Fluticasone
  • Bacitracin
  • Beclomethasone
  • Benzoic Acid; Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate
  • Benztropine
  • Betamethasone
  • Bismuth Subcitrate Potassium; Metronidazole; Tetracycline
  • Bismuth Subsalicylate; Metronidazole; Tetracycline
  • Budesonide
  • Budesonide; Formoterol
  • Bupivacaine
  • Bupivacaine Liposomal
  • Bupivacaine; Lidocaine
  • Chloroprocaine
  • Cholinergic agonists
  • Ciclesonide
  • Cisatracurium
  • Clomipramine
  • Cocaine
  • Colistimethate, Colistin, Polymyxin E
  • Corticosteroids
  • Cortisone
  • Deflazacort
  • Demeclocycline
  • Desipramine
  • Dexamethasone
  • Dextromethorphan; Quinidine
  • Dicyclomine
  • Digoxin
  • Disopyramide
  • Doxepin
  • Doxycycline
  • Edrophonium
  • Etomidate
  • Fludrocortisone
  • Flunisolide
  • Fluticasone
  • Fluticasone; Salmeterol
  • Fluticasone; Umeclidinium; Vilanterol
  • Fluticasone; Vilanterol
  • Formoterol; Mometasone
  • Fospropofol
  • Gentamicin
  • Glycopyrrolate
  • Glycopyrrolate; Formoterol
  • Halogenated Anesthetics
  • Hetastarch; Dextrose; Electrolytes
  • Homatropine; Hydrocodone
  • Hydrocortisone
  • Hyoscyamine
  • Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate; Sodium Biphosphate
  • Imipramine
  • Indacaterol; Glycopyrrolate
  • Kanamycin
  • Ketamine
  • Levobupivacaine
  • Lidocaine
  • Lidocaine; Prilocaine
  • Magnesium
  • Magnesium Salts
  • Maprotiline
  • Mecamylamine
  • Mepivacaine
  • Mepivacaine; Levonordefrin
  • Methenamine; Sodium Acid Phosphate; Methylene Blue; Hyoscyamine
  • Methocarbamol
  • Methscopolamine
  • Methylprednisolone
  • Minocycline
  • Mivacurium
  • Mometasone
  • Neostigmine
  • Nonsteroidal antiinflammatory drugs
  • Nortriptyline
  • Omadacycline
  • Oxybutynin
  • Pancuronium
  • Paromomycin
  • Perphenazine; Amitriptyline
  • Physostigmine
  • Plazomicin
  • Polymyxin B
  • Polymyxins
  • Prednisolone
  • Prednisone
  • Prilocaine
  • Prilocaine; Epinephrine
  • Procainamide
  • Procaine
  • Propantheline
  • Propofol
  • Protriptyline
  • Quinidine
  • Quinine
  • Rocuronium
  • Sarecycline
  • Scopolamine
  • Streptomycin
  • Succinylcholine
  • Tetracaine
  • Tetracycline
  • Tetracyclines
  • Tobramycin
  • Triamcinolone
  • Tricyclic antidepressants
  • Trihexyphenidyl
  • Trimipramine
  • Vecuronium
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