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
[Outline]
- 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).
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