pyridostigmine (Mestinon) (cont.)

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PREPARATIONS: Oral: 60 mg tablets, 60 mg/5 ml syrup, 180 mg timespan (slow release) tablets.

STORAGE: Pyridostigmine tablets and syrup should be stored at room temperature between 59 F to 86 F (15 C to 30 C). Pyridostigmine should be protected from light.


  • For the treatment of myasthenia gravis in adults: The dose and frequency of administration must be adjusted to the needs of the individual patient.
  • The average dose is ten 60 mg regular release tablets or ten 5-ml teaspoonful (600 mg).
  • In individuals with severe disease, as many as 25 doses (1 dose = 60 mg regular release tablet or 5 ml syrup) may be required.
  • For in mild disease, 1 to 6 doses may be sufficient.
  • If using timespan tablets, one to three 180 mg tablets (180 to 540 mg) once or twice daily usually would be sufficient for providing adequate symptom control. Administration of timespan tablets should be separated by at least 6 hours. To provide coverage for break-thru symptoms, use of more rapidly acting regular tablets or syrup with timespan tablets may be necessary.
  • The safety and effectiveness of pyridostigmine use in pediatrics has not been established.
  • As pyridostigmine is primarily removed from the body by the kidneys, lower doses may be required in patients with kidney disease.

DRUG INTERACTIONS: Pyridostigmine should not be used with other cholinesterase inhibitors such as neostigmine (Bloxiverz, Prostigmin) or edrophonium (Tensilon, Enlon, Reversol) because of the risk of additive toxicity.

Use of quinine (Qualaquin) with pyridostigmine should be avoided as the actions of quinine on skeletal muscle are opposite to those of pyridostigmine.

PREGNANCY: The safety of pyridostigmine during pregnancy has not been evaluated. Therefore, pyridostigmine should only be used during pregnancy if the benefits of treatment outweigh the potential risk to the mother and the unborn baby. Pyridostigmine is classified as FDA pregnancy risk category C.

NURSING MOTHERS: Pyridostigmine can be excreted into human milk. The American Academy of Pediatrics considers pyridostigmine to be generally compatible with nursing. Pyridostigmine should be used cautiously in nursing mothers.

REFERENCE: FDA Prescribing Information.

Medically Reviewed by a Doctor on 5/11/2015

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