Adult Dosing

Myasthenia gravis

• Immediate release:
• Start 60 mg PO q8 hrs; then adjust as required
• Usual dose: 60-120 mg PO q3-8 hrs; 600-1500 mg/day. [Max: 1500 mg/day]

• Extended release:
• 180-540 mg PO q12-24 hrs; dosing interval must be atleast 6 hrs
• Concurrent immediate-release products may be required

Pediatric Dosing

• Safety and effectiveness in pediatric patients have not been established

[Outline]

• Adult Dosing
• Pediatric Dosing

• Myasthenia gravis

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

Renal Dose Adjustment

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

Hepatic Dose Adjustment

• Hepatic impairment: Dose adjustments not defined

• Overdosage of therapy may result in cholinergic crisis which is characterized by increasing muscle weakness and which may lead to death
• 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
• Use smaller dosage in patients with renal disease as pyridostigmine is mainly excreted unchanged by the kidney

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 last accessed 14 March 2011). 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 14 March 2011). According to manufacturer data evaluate risk vs benefit ratio prior to administering therapy.

• CNS: Cholinergic crisis, seizures, dizziness, weakness, syncope, paralysis, headache, paresthesias, fatigue/malaise
• EENT: Lacrimation, miosis, rhinorrhea, blurred vision
• RESP: Bronchospasm, excessive secretions, respiratory depression, respiratory arrest, respiratory paralysis, pulmonary edema
• CV: Bradycardia, severe hypotension, AV block, arrhythmias, hypertension, cardiac arrest
• GI: Abdominal cramps, diarrhea, excessive salivation, nausea, vomiting, flatulence, dyspepsia
• DERM: Rashes, diaphoresis
• GU: Urinary frequency or urgency
• MUSC: Fasciculations, muscle weakness or cramps
• HYPERSENSITIVITY: Anaphylaxis, hypersensitivity reactions

• 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

US Availability

pyridostigmine (generic)

• TABS: 60 mg

Mestinon

• TABS: 60 mg
• SYRUP: 60 mg/5 mL
• ETABS: 180 mg

Canadian Trade Name(s)

• Mestinon
• Mestinon-SR

Canadian Availability

Mestinon

• TABS: 60 mg

Mestinon-SR

• ETABS: 180 mg

UK Trade Name(s)

• Mestinon

UK Availability

Mestinon

• TABS: 60 mg

Australian Trade Name(s)

• Mestinon
• Mestinon Timespan

Australian Availability

Mestinon

• TABS: 10, 60 mg

Mestinon Timespan

• TABS: 180 mg

[Outline]

Psychiatric

Cholinesterase Inhibitors

Neurologic

Cholinesterase Inhibitors

Pricing data from www.DrugStore.com in U.S.A.

• Mestinon 60 MG/5ML SYRP [Bottle] (VALEANT)
  240 5ml = $95.99
  480 5ml = $179.96
• Pyridostigmine Bromide 60 MG TABS [Bottle] (GLOBAL PHARMACEUTICAL CORP)
  30 mg = $21.99
  90 mg = $49.97
• Mestinon 60 MG TABS [Bottle] (VALEANT)
  30 mg = $97
  90 mg = $260.47
• Mestinon 180 MG TBCR [Bottle] (VALEANT)
  30 mg = $127.99
  90 mg = $365.97

Warning: This pricing information is subject to change at the sole discretion of DS Pharmacy. For the most current and up-to-date pricing information, please visit drugstore.com.

• Mestinon 180 MG Extended Release Tablet (Valeant Pharmaceuticals, Inc.)
• Mestinon 60 MG Oral Tablet (Valeant Pharmaceuticals, Inc.)
• Pyridostigmine Bromide 30 MG Oral Tablet (Valeant Canada Limited)
• Pyridostigmine Bromide 60 MG Oral Tablet (Corepharma LLC)
• Pyridostigmine Bromide 60 MG Oral Tablet (Global Pharmaceuticals, Division of Impax Laboratories Inc.)
• Pyridostigmine Bromide 60 MG Oral Tablet (Oceanside Pharmaceuticals)
• Pyridostigmine Bromide 60 MG Oral Tablet (Sandoz Inc)