Mestinon®
GoodRxPyridostigmine Bromide · oral tablet
Misc.
Approved uses
Myasthenia gravis
Ordinary tablets, average 600 mg daily across 5 or 6 doses, adjusted to response; the 180 mg extended-release tablet is used for overnight cover
Ocular myasthenia is what an optometrist meets first: ptosis and variable diplopia, worse through the day
Contraindications
Pyridostigmine bromide is contraindicated in patients with: Mechanical intestinal or urinary obstruction Known hypersensitivity to pyridostigmine or other anticholinesterase agents Mechanical intestinal or urinary obstruction.
Available FormsPyridostigmine bromide 60 mg tablets, 180 mg extended-release tablets, and a raspberry-flavoured oral solution of 60 mg per 5 mL.
Mechanism of ActionPyridostigmine is a reversible cholinesterase inhibitor.
Warnings & Precautions
- Cholinergic crisis and myasthenic crisis can look alike; distinguishing them matters because the treatment differs.
- Use with caution in bronchial asthma, and in patients receiving a bradycardic drug.
- Atropine may mask the early signs of overdose.
- Bromide sensitivity has been reported, presenting as a skin rash.
Common Side Effects
The most common adverse reactions (≥ 3%) are diarrhea, abdominal pain, dysmenorrhea, and twitch.
Pregnancy & LactationPregnancy: Safety during pregnancy has not been established; weigh the benefit against the possible hazard.
Lactation: Pyridostigmine is present in human milk in small amounts.
Pediatric UseSafety and effectiveness in pediatric patients have not been established.