Adult Dosing

Myasthenia gravis

• 2 mg IM/IV; may be repeated q 2–3 hrs
• During labor/delivery; 1 mg before second stage of labor is complete

Antagonist to non depolarizing muscle relaxants

• 0.1 to 0.25 mg/kg IV: pretreat with 0.6–1.2 mg atropine IV

Pediatric Dosing

• Safety and efficacy in pediatric patients have not been established

• Myasthenia gravis
• As a reversal agent or antagonist to non depolarizing muscle relaxants

• Hypersensitivity to any of the ingredients of the product or bromides
• GI obstruction
• GU tract obstruction

• This drug should only be administered by adequately trained individuals familiar with its actions, characteristics and hazards

Renal Dose Adjustment

• Renal impairment: Dose adjustments not defined, reduction in dosage recommended

Hepatic Dose Adjustment

• Hepatic impairment: Dose adjustments not defined

• Cautiously administer in patients with bronchial asthma or cardiac dysrhythemias
• Death may occur due to overdosage through involvement of the muscles of the respiration
• Observe patients closely for cholinergic reactions; differentiation from myasthenic crisis is important because increasing the dose of pyridostigmine may have grave consequences in patients in cholinergic crisis
• Adequate recovery of voluntary respiration and neuromuscular transmission must be obtained prior to discontinuation of respiratory assistance and carefully monitor patients when used as an antagonist to nondepolarizing muscle relaxants

Cautions: Use cautiously in

• Renal impairment
• Hx of asthma
• COPD
• Peptic ulcer disease
• GERD
• CV disease
• Bradycardia
• Arrhythmias
• Cardiac conduction defects
• Hx of epilepsy
• Hyperthyroidism

Pregnancy Category:C

Breastfeeding: Due to the low levels of pyridostigmine in breastmilk, amounts ingested by the infant are small and would not be expected to adversely affect the breastfed infant. This information is based upon LactMed database (available at http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT). This drug is compatible and considered safe with breastfeeding based upon data from AAP Policy Guidelines (available at http://aappolicy.aappublications.org/cgi/content/full/pediatrics;108/3/776 last accessed 15 June 2011).

• GI: Nausea, diarrhea, vomiting, abdominal cramps, increased peristalsis, increased salivation
• RESP: Increased bronchial secretions
• EENT: Miosis
• DERM: Diaphoresis, rash
• MUSC: Cramps, fasciculation
• LOCAL: Thrombophlebitis
• MISC: Weakness

• Cholinergic; inhibits the breakdown of acetylcholine and prolongs its effects
• Poorly absorbed from the GI tract
• Metabolized by liver; plasma (cholinesterases)
• Renally excreted (primarily unchanged)
• Half-life: 3.7 hrs

US Trade Name(s)

• Mestinon
• Regonol

US Availability

Mestinon

• INJ: 5 mg/mL (2 mL amp)

Regonol

• INJ: 5 mg/mL (2 mL amp, 5 mL vial)

Canadian Trade Name(s)

• N/A

Canadian Availability

• N/A

UK Trade Name(s)

• N/A

UK Availability

• N/A

Australian Trade Name(s)

• N/A

Australian Availability

• N/A

Psychiatric

Cholinesterase Inhibitors

Neurologic

Cholinesterase Inhibitors