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NERVOUS SYSTEM › OTHER NERVOUS SYSTEM DRUGS › PARASYMPATHOMIMETICS › Anticholinesterases
pyridostigmine
N07AA02
Forms & Strengths
- Oral Tablet: 60 mg
- Extended-Release Tablet: 180 mg
- Oral Syrup: 60 mg/5 mL
- Injection: 5 mg/mL
Adult Dosing
- Myasthenia Gravis: 60 to 120 mg orally q3h to q6h; daily dose typically ranges from 300 to 1200 mg
- Extended-Release: 180 to 540 mg orally once or twice daily (at least 6 hours apart)
- Reversal of Nondepolarizing Neuromuscular Blockade: 10 to 20 mg IV administered with atropine or glycopyrrolate
Pediatric Dosing
- Myasthenia Gravis: 7 mg/kg/day orally divided into 5 to 6 doses
- Reversal of Nondepolarizing Neuromuscular Blockade (Neonates/Pediatrics): 0.05 to 0.15 mg/kg IV with atropine
Indications
- Symptomatic treatment of myasthenia gravis
- Reversal of nondepolarizing neuromuscular blocking agents
- Off-label: Prophylaxis against nerve gas (soman) poisoning in military personnel
Mechanism of Action
- Reversible acetylcholinesterase inhibitor
- Inhibits the destruction of acetylcholine by acetylcholinesterase at the neuromuscular junction
- Facilitates transmission of impulses across the myoneural junction to increase muscle strength
Contraindications
- Hypersensitivity to pyridostigmine or bromides
- Mechanical intestinal obstruction
- Mechanical urinary tract obstruction
Adverse Reactions
- Muscarinic effects: excessive salivation, lacrimation, diaphoresis, nausea, vomiting, diarrhea, abdominal cramps, miosis
- Nicotinic effects: muscle fasciculations, muscle cramps, weakness
- Cardiovascular: bradycardia, hypotension
Drug Interactions
- Depolarizing neuromuscular blockers (e.g., succinylcholine): effects may be prolonged
- Nondepolarizing neuromuscular blockers: antagonism of blockade
- Anticholinergics (e.g., atropine, scopolamine): may antagonize muscarinic symptoms of pyridostigmine
- Beta-blockers: potential additive bradycardia
Curated Content: Needs Vetting Before Put to Clinical Use