Trade Names:Mestinon- Tablets 60 mg- Tablets, extended-release 180 mg- Syrup 60 mg/5 mL- Injection 5 mg/mLMestinon-SR (Canada)
Facilitates myoneural junction impulse transmission by inhibiting acetylcholine destruction by cholinesterase.
Primarily excreted unchanged by the kidney.
Treatment of myasthenia gravis; reversal agent or antagonist to nondepolarizing muscle relaxants such as curariform drugs and gallamine triethiodide (IV only).
Mechanical intestinal or urinary obstruction; hypersensitivity to anticholinesterase agents.
PO Individualize dosage to meet the needs of the patients.Syrup/Conventional tablet
Average dose is ten 5 mL tsp (60 mg/5 mL) daily or ten 60 mg tablets spaced to provide max relief when max strength is needed (range is usually 1 to 25 tablets or tsp/day).Extended-release tablets
One to three 180 mg tablets, once or twice daily with at least 6 h between doses.
IV To supplement oral dosage preoperatively and postoperatively during labor and postpartum, during myasthenic crisis, or when oral therapy is impractical, give approximately 1/30 the oral dose, either IM or very slow IV.Neonates
IV Neonates of myasthenic mothers may have transient difficulty in swallowing, sucking, and breathing. Injectable pyridostigmine may be indicated (by symptoms and use of the edrophonium test) until syrup can be taken. Dosage requirements range from 0.05 to 0.15 mg/kg IM.Reversal of Nondepolarizing Muscle RelaxantsInjection
Give atropine sulfate (0.6 to 1.2 mg) IV immediately prior to pyridostigmine to minimize adverse reactions. Pyridostigmine 10 or 20 mg IV is usually sufficient. Full recovery usually occurs in no more than 15 min but at least 30 min may be required.
May mask signs of overdosage, leading to inadvertent induction of cholinergic crisis.Corticosteroids
The therapeutic effects of pyridostigmine may be antagonized.Succinylcholine
Neuromuscular blockade produced by succinylcholine may be prolonged or antagonized.
None well documented.
Nausea; vomiting; diarrhea; abdominal cramps; increased peristalsis; increased salivation.
Muscle cramps and fasciculation; weakness.
Increased bronchial secretions.
Category C .
Excreted in breast milk.
Lower doses may be required in patients with renal disease.
Use with caution.
Use with caution. Transient bradycardia may occur and be relieved by atropine sulfate.
Observe patients closely for cholinergic reactions, particularly if the IV route is used. May be difficult to distinguish from myasthenic crisis. Differentiation is important because increasing the dose of pyridostigmine or other drugs of this class may have grave consequences in patients in cholinergic crisis.
Cholinergic crisis, characterized by increasing muscle weakness (including respiratory paralysis and death).
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