Dosing & Uses
Dosage Forms & Strengths
inj solution
- 5mg/mL
tablet, controlled release
- 180mg
tablet
- 60mg
syrup
- 60mg/5mL (240mL)
Myasthenia Gravis
Tablets/syrup: 600 mg/day spaced to provide maximum relief
Sustained release: 180-540 mg PO qDay or q12hr; not to exceed 1.5 g/day
Reversal of Nondepolarizing Muscle Relaxants
10-20 mg generally effective; full recovery may occur as early as <15 min but may require >30 min
To minimize side effects 0.6-1.2 mg IV atropine sulfate recommended immediately prior to pyridostigmine
Pretreatment for Soman Nerve Gas Exposure
30 mg PO q8hr beginning several hours prior to exposre
Discontinue at first sign of nerve agent exposure then begin atropine and pralidoxime
Dosage Forms & Strengths
inj solution
- 5mg/mL
tablet, controlled release
- 180mg
tablet
- 60mg
syrup
- 60mg/5mL (240mL)
Myasthenia Gravis
Children
Neonates
Reversal of Nondepolarizing Muscle Relaxants
0.1-0.25 mg/kg/dose IV
Dosing range: 0.1-0.25 mg/kg/dose; full recovery may occur as early as <15 min but may require >30 min
Interactions
Interaction Checker
No Results
Contraindicated
Serious - Use Alternative
Significant - Monitor Closely
Minor
Contraindicated (0)
Serious - Use Alternative (2)
- ponesimod
ponesimod, pyridostigmine. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Consult cardiologist if considering treatment. Coadministration of ponesimod with drugs that decrease HR may have additive effects on decreasing HR and should generally not be initiated in these patients.
- triamcinolone acetonide injectable suspension
triamcinolone acetonide injectable suspension, pyridostigmine. unspecified interaction mechanism. Avoid or Use Alternate Drug. Concomitant use of anticholinesterase agents and corticosteroids may produce severe weakness in patients with myasthenia gravis. If possible, withdraw anticholinesterase agents at least 24 hours before initiating corticosteroid therapy.
Monitor Closely (66)
- aclidinium
pyridostigmine increases and aclidinium decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- amifampridine
amifampridine and pyridostigmine both increase cholinergic effects/transmission. Use Caution/Monitor.
- amitriptyline
pyridostigmine increases and amitriptyline decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.
- amoxapine
pyridostigmine increases and amoxapine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- anticholinergic/sedative combos
pyridostigmine increases and anticholinergic/sedative combos decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- atracurium
pyridostigmine increases and atracurium decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- atropine
pyridostigmine increases and atropine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- atropine IV/IM
pyridostigmine increases and atropine IV/IM decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor. .
- belladonna alkaloids
pyridostigmine increases and belladonna alkaloids decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- belladonna and opium
pyridostigmine increases and belladonna and opium decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- bethanechol
bethanechol and pyridostigmine both increase cholinergic effects/transmission. Use Caution/Monitor.
- carbachol
carbachol and pyridostigmine both increase cholinergic effects/transmission. Use Caution/Monitor.
- cevimeline
cevimeline and pyridostigmine both increase cholinergic effects/transmission. Use Caution/Monitor.
- cisatracurium
pyridostigmine increases and cisatracurium decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- clomipramine
pyridostigmine increases and clomipramine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- cyclizine
pyridostigmine increases and cyclizine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- cyclobenzaprine
pyridostigmine increases and cyclobenzaprine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- darifenacin
pyridostigmine increases and darifenacin decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- dicyclomine
pyridostigmine increases and dicyclomine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- diphenhydramine
pyridostigmine increases and diphenhydramine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- donepezil
donepezil and pyridostigmine both increase cholinergic effects/transmission. Use Caution/Monitor.
- dosulepin
pyridostigmine increases and dosulepin decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- doxepin
pyridostigmine increases and doxepin decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- echothiophate iodide
echothiophate iodide and pyridostigmine both increase cholinergic effects/transmission. Use Caution/Monitor.
- fesoterodine
pyridostigmine increases and fesoterodine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- flavoxate
pyridostigmine increases and flavoxate decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- galantamine
galantamine and pyridostigmine both increase cholinergic effects/transmission. Use Caution/Monitor.
- glycopyrrolate
pyridostigmine increases and glycopyrrolate decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- glycopyrrolate inhaled
pyridostigmine increases and glycopyrrolate inhaled decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- henbane
pyridostigmine increases and henbane decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- homatropine
pyridostigmine increases and homatropine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- huperzine A
huperzine A and pyridostigmine both increase cholinergic effects/transmission. Use Caution/Monitor.
- hyoscyamine
pyridostigmine increases and hyoscyamine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- hyoscyamine spray
pyridostigmine increases and hyoscyamine spray decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor. .
- imipramine
pyridostigmine increases and imipramine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- ipratropium
pyridostigmine increases and ipratropium decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- lofepramine
pyridostigmine increases and lofepramine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- maprotiline
pyridostigmine increases and maprotiline decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- meclizine
pyridostigmine increases and meclizine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- methscopolamine
pyridostigmine increases and methscopolamine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- neostigmine
neostigmine and pyridostigmine both increase cholinergic effects/transmission. Use Caution/Monitor.
- nortriptyline
pyridostigmine increases and nortriptyline decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- onabotulinumtoxinA
pyridostigmine increases and onabotulinumtoxinA decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- orphenadrine
pyridostigmine increases and orphenadrine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- oxybutynin
pyridostigmine increases and oxybutynin decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- oxybutynin topical
pyridostigmine increases and oxybutynin topical decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- oxybutynin transdermal
pyridostigmine increases and oxybutynin transdermal decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- pancuronium
pyridostigmine increases and pancuronium decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- physostigmine
physostigmine and pyridostigmine both increase cholinergic effects/transmission. Use Caution/Monitor.
- pilocarpine
pilocarpine and pyridostigmine both increase cholinergic effects/transmission. Use Caution/Monitor.
- pilocarpine ophthalmic
pilocarpine ophthalmic and pyridostigmine both increase cholinergic effects/transmission. Use Caution/Monitor.
- pralidoxime
pyridostigmine increases and pralidoxime decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- propantheline
pyridostigmine increases and propantheline decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- protriptyline
pyridostigmine increases and protriptyline decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- rapacuronium
pyridostigmine increases and rapacuronium decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- rivastigmine
pyridostigmine and rivastigmine both increase cholinergic effects/transmission. Use Caution/Monitor.
- rocuronium
pyridostigmine increases and rocuronium decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- scopolamine
pyridostigmine increases and scopolamine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- solifenacin
pyridostigmine increases and solifenacin decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- succinylcholine
pyridostigmine and succinylcholine both increase cholinergic effects/transmission. Use Caution/Monitor.
- tiotropium
pyridostigmine increases and tiotropium decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- tolterodine
pyridostigmine increases and tolterodine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- trimipramine
pyridostigmine increases and trimipramine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- trospium chloride
pyridostigmine increases and trospium chloride decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- umeclidinium bromide
pyridostigmine increases and umeclidinium bromide decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor. Monitor when umeclidinium bromide is coadministered with cholinergic agents.
- vecuronium
pyridostigmine increases and vecuronium decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Use Caution/Monitor.
Minor (6)
- desipramine
pyridostigmine increases and desipramine decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Minor/Significance Unknown.
- donepezil
donepezil increases effects of pyridostigmine by pharmacodynamic synergism. Minor/Significance Unknown.
- galantamine
galantamine increases effects of pyridostigmine by pharmacodynamic synergism. Minor/Significance Unknown.
- pantothenic acid
pantothenic acid, pyridostigmine. Either increases effects of the other by pharmacodynamic synergism. Minor/Significance Unknown.
- procainamide
procainamide decreases effects of pyridostigmine by pharmacodynamic antagonism. Minor/Significance Unknown.
- trazodone
pyridostigmine increases and trazodone decreases cholinergic effects/transmission. Effect of interaction is not clear, use caution. Minor/Significance Unknown.
Adverse Effects
Fewer GI effects than neostigmine
Frequency Not Defined
Cholinergic effects (N/V, increases peristalsis, increases salivation, urinary frequency
Weakness
Hypotension
ECG changes
Loss of consciousness
Convulsions
Drowsiness
Thrombophlebitis
Urticaria
Arrhythmia
Laryngospasm
Bradycardia
Cardiac standstill (rare)
Cholinergic crisis (rare)
Transient rash in bromide-sensitive patients
Warnings
Black Box Warning
Therapy must be administered by trained personnel
Contraindications
Hypersensitivity
Mechanical intestinal or urinary obstruction
Cautions
Caution in epilepsy, asthma, COPD, recent MI, hypertension, vagotonia, hyperthyroidism, dysrhythmia
Keep atropine and epinephrine immediately available to treat hypersensitivity reactions resulting from therapy
Injection unstable in alkaline solutions
If symptoms of excess cholinergic activity occur discontinue therapy
Anticholinesterase sensitivity may develop for brief or prolonged periods
Pregnancy & Lactation
Pregnancy Category: B
Lactation: Compatible
Pregnancy Categories
A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.
B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk. C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done. D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk. X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist. NA: Information not available.Pharmacology
Mechanism of Action
Anticholinesterase agent which inhibits metabolism of acetylcholine by acetylcholinesterase thereby enhancing its cholinergic effects fascilitating impulses across myoneural junction
Pharmacokinetics
Half-Life: 1-2 hr (IV)
Onset: 15-30 min (PO/IM); 2-5 min (IV)
Duration: 6-8 hr (PO); 2-3 hr (IV)
Bioavailability: 10-20%
Distribution: ~19 L
Metabolism: Liver microsomal enzymes
Metabolites: 3-hydroxy-N-methylpyridinium
Total Body Clearance: 8.5-9.7 mL/min/kg
Excretion: Urine (80-90%)
Administration
IV Compatibilities
Syringe: glycopyrrolate
Y-site: heparin, hydrocortisone Na-succinate, KCl, vit B/C
Other Information
IV Administration: very slow injection
Images
| BRAND | FORM. | UNIT PRICE | PILL IMAGE |
|---|---|---|---|
| Regonol injection - | 5 mg/mL solution |  | |
| Mestinon Timespan oral - | 180 mg tablet |  | |
| Mestinon oral - | 60 mg/5 mL solution |  | |
| pyridostigmine bromide oral - | 60 mg tablet |  | |
| pyridostigmine bromide oral - | 60 mg/5 mL solution |  | |
| pyridostigmine bromide oral - | 60 mg/5 mL solution |  | |
| pyridostigmine bromide oral - | 60 mg tablet |  | |
| pyridostigmine bromide oral - | 180 mg tablet | | |
| pyridostigmine bromide oral - | 60 mg tablet |  | |
| pyridostigmine bromide oral - | 180 mg tablet |  | |
| pyridostigmine bromide oral - | 60 mg tablet |  | |
| pyridostigmine bromide oral - | 180 mg tablet |  |
Copyright © 2010 First DataBank, Inc.
Patient Handout
pyridostigmine bromide injection
NO MONOGRAPH AVAILABLE AT THIS TIME
USES: Consult your pharmacist.
HOW TO USE: Consult your pharmacist.
SIDE EFFECTS: Consult your pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.
PRECAUTIONS: Consult your pharmacist.
DRUG INTERACTIONS: Consult your pharmacist.Keep a list of all your medications with you, and share the list with your doctor and pharmacist.
OVERDOSE: If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center.
NOTES: No monograph available at this time.
MISSED DOSE: Consult your pharmacist.
STORAGE: Consult your pharmacist.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company for more details about how to safely discard your product.
Information last revised July 2016. Copyright(c) 2021 First Databank, Inc.
IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.
Formulary
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