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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
- abdominal pain
- agitation
- alopecia
- amblyopia
- borborygmi
- bronchial secretions
- confusion
- depression
- diaphoresis
- diarrhea
- drowsiness
- dysmenorrhea
- epistaxis
- fecal incontinence
- flatulence
- hallucinations
- headache
- hyperesthesia
- hyperhidrosis
- hypersalivation
- hypertonia
- increased urinary frequency
- lacrimation
- lethargy
- miosis
- muscle cramps
- myalgia
- nausea
- ocular pain
- pallor
- phlebitis
- rash
- restlessness
- seizures
- syncope
- urinary incontinence
- vertigo
- vomiting
- weakness
- 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