Mestinon (Pyridostigmine)
Class and Category of Drug
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Chemical class: Bromide dimethylcarbamate
Therapeutic class: Antimyasthenic
Pregnancy category: Not rated
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Drug Indications and Dosages
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To treat symptoms of my asthenia gr avis
Extended-Release Tablets
Adults and adolescents. 180 to 540 mg once or twice daily (at least 6 hr between doses).
Syrup,Tablets
Adults and adolescents. Initial: 30 to 60 mg every 3 to 4 hr, adjusted as needed. Maintenance: 60 mg to 1.5 g daily.
Children. 7 mg/kg daily in 5 or 6 divided doses.
I.V. or intramuscular Injection
Adults and adolescents. 2 mg every 2 to 3hr.
I.M. Injection
Neonates of myasthenic mothers. 0.05 to 0.15 mg/kg every 4 to 6 hr.
To reverse the effects of neuromuscular blockers
Intravenous Injection
Adults and adolescents. 10 to 20 mg after 0.6 to 1.2 mg of intravenous atropine has been given.
Dosage Adjustment
Dosage possibly reduced for patients with renal impairment.
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Contraindications of Drug
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Hypersensitivity to pyridostigmine or its components, mechanical obstruction of gastrointestinal or urinary tract
Generic Drug Interactions
Drugs
aminoglycosides (systemic), anesthetics (hydrocarbon inhalation), capreomycin, lidocaine (I.V.), lincomycins, polymyxins, quinine: Possibly antagonized effect of pyridostigmine on skeletal muscle; possibly decreased neuromuscular blocking activity of these drugs (with large doses of pyridostigmine)
anesthetics (local): Inhibited neuronal transmission, increased anesthesia effects anticholinergics: Possibly masked pyridostigmine overdose; reduced intestinal motility
cholinesterase inhibitors: Increased risk of additive toxicity
edrophonium: Possibly worsening of status guanadrel, guanethidine, mecamylamine, neuromuscular blockers, procainamide: Possibly prolonged phase I blocking effect or reversal of nondepolarization blockade
quinidine, trimethaphan: Possibly antagonized effects of pyridostigmine
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Drugs Adverse Reactions
Eyes, Ears, Nose, And Throat: Increased salivation, lacrimation, miosis
Gastrointestinal: Abdominal cramps, diarrhea, increased peristalsis, nausea, vomiting
Genitourinary: Urinary frequency, incontinence, or urgency
Musculoskeletal: Fasciculations, muscle spasms or weakness
Respiratory: Increased tracheobronchial secretions
Skin: Diaphoresis
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Nursing Considerations for Generic Drugs
• Use pyridostigmine cautiously in patients with renal disease because drug is mainly excreted unchanged by kidneys. Monitor BUN and serum creatinine levels.
WARNING Maintain a rigid dosing schedule because a missed or late dose can precipitate myasthenic crisis.
• Observe for cholinergic reactions when administering drug intravenous or I.M.
WARNING Pyridostigmine overdose may obscure diagnosis of myasthenic crisis because main symptom in both is muscle weakness. Treat cholinergic crisis by stopping anticholinesterase, giving atropine as prescribed, and helping with endotracheal intubation and mechanical ventilation, if needed.
• Be aware that reversal of neuromuscular blockade usually occurs in 15 to 30 minutes. Be prepared to maintain patent airway and ventilation until normal voluntary respiration returns completely. Assess respiratory measurements and muscle tone with peripheral nerve stimulator device, as indicated.
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Pyridostigmine
Preparations
International Brand Drug Names
The information about drugs (tablets, pills, capsules, creams, solution, nasal spray, inhaler) around the world.
British Pharmacopoeia, 2008 edition: Pyridostigmine Tablets;
The United States Pharmacopeia 31, 2008: Pyridostigmine Bromide Injection; Pyridostigmine Bromide Syrup; Pyridostigmine Bromide Tablets.
Proprietary Preparations
Argentina: Mestinon; Piridos;
Australia: Mestinon;
Austria: Mestinon;
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