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Pyridostigmine bromide
Pyridostigmine bromide (Mestinon)
Pyridostigmine bromide
(peer-id-oh-STIG-meen)
Pregnancy Category: C Mestinon Mestinon-SR Regonol (Rx)

Classification: Indirectly acting cholinergic-acetylcholinesterase inhibitor

See Also: For all information, see also Neostigmine.

Action/Kinetics: Has a slower onset, longer duration of action, and fewer side effects than neostigmine. Onset, PO: 30-45 min for syrup and tablets and 30-60 min for extended-release tablets; IM: 15 min; IV: 2-5 min. Duration, PO: 3-6 hr for syrup and tablets and 6-12 hr for extended-release tablets; IM, IV: 2-4 hr. Poorly absorbed from the GI tract; excreted in urine up to 72 hr after administration.

Uses: Myasthenia gravis. Antidote for nondepolarizing muscle relaxants (e.g., tubocurarine).

Additional Contraindications Sensitivity to bromides.

Special Concerns: Safe use during pregnancy and during lactation has not been established. May cause uterine irritability and premature labor if given IV to pregnant women near term. Duration of action may be increased in the elderly.

Additional Side Effects Skin rash. Thrombophlebitis after IV use.

Overdose Management: Symptoms: Abdominal cramps, vomiting, diarrhea, epigastric distress, excessive salivation, cold sweating, pallor, blurred vision, urinary urgency, fasciculation and paralysis of voluntary muscles (including the tongue), miosis, increased BP (may be accompanied by bradycardia), sensation of internal trembling, panic, severe anxiety. Treatment: Discontinue medication temporarily. Give atropine, 0.5-1 mg IV (up to 5-10 mg or more may be needed to get HR to 80 beats/min). Supportive treatment including artificial respiration and oxygen.

How Supplied: Injection: 5 mg/mL; Syrup: 60 mg/5 mL; Tablet: 60 mg; Tablet, extended release: 180 mg

Dosage
•Syrup, Tablets Myasthenia gravis.
Adults: 60-120 mg q 3-4 hr with dosage adjusted to client response. Maintenance: 600 mg/day (range: 60 mg-1.5 g). Pediatric: 7 mg/kg (200 mg/m²) daily in five to six divided doses.
•Sustained-Release Tablets Myasthenia gravis.
Adults: 180-540 mg 1-2 times/day with at least 6 hr between doses. Sustained-release tablets not recommended for use in children.
•IM, IV Myasthenia gravis.
Adults, IM, IV: 2 mg (about &frac130; the adult dose) q 2-3 hr.
Neonates of myasthenic mothers.
IM: 0.05-0.15 mg/kg q 4-6 hr.
Antidote for nondepolarizing drugs.
Adults, IV: 10-20 mg with 0.6-1.2 mg atropine sulfate given IV.