Pyridostigmine

Indications & Dose:

• BY MOUTH

Adult

• Myasthenia gravis:

PO 300-1200 mg/day divided to provide max relief; usual range 60-1500 mg/day, individualize dosage; PO SUS REL 180540 mg qd-bid, individualize dosage, use dosage intervals of at least 6 hr; IM/IV 1/30th PO dose, inj IV very slowly

Paralytic ileus:

• BY MOUTH

60-240 mg; as required

• Reversal of non-depolarizing neuromuscular blockade

• BY INTRAVENOUS

IV 10-20 mg; give atropine 0.6-1.2 mg IV immediately prior to pyridostigmine to minimize side effects.

Child/Neonates

• Myasthenia gravis

• BY MOUTH

5-10mg 4hourly, under 6 years, initially 30mg, 6-12 years, initially 60mg increase by 15-30mg daily untill controll.

Paralytic ileus:

BY MOUTH

15-60mg as required

• Reversal of non-depolarizing neuromuscular blockade:

• BY INTRAVENOUS

IV 0.1-0.25 mg/kg/dose preceded by atropine or glycopyrrolate. 

Contraindications:

Side Effects:

Cautions:

Precautions:

Seizure disorder, bronchial asthma, bradycardia, recent coronary occlusionvagotonia, hyperthyroidism, cardiac dysrhythmias, peptic ulcer, large oral dosesin megacolon and decreased GI mortility (accumulation and toxicity may occur when motility is restored), anticholinesterase insensitivity (reduce or withhold dosages until patient again becomes sensitive)  

Interaction:

Drugs
Beta Blockers: Additive bradycardia
Tacrine: Increased anticholinergic effects 

Warnings:

Adverse Effects:

Lactations:

Pregnancy ; would not be expected to cross the placenta because it is ionized at physiologic pH; although apparently safe for the fetus, may cause transient muscle weakness in the newborn; compatible with breast feeding

Special Precautions:

Counselling:

Side Effects Or Adverse Reactions:

CNS: Dizziness, drowsiness, headache, incoordination, loss of consciousness, paralysis, seizures
CV: AV block, bradycardia, cardiac arrest, dysrhythmias, hypotension, nodal rhythm, non-specific ECG changes, syncope, tachycardia
EENT: Blurred vision, conjunctival hyperemia, diplopia, lacrimation, miosis, spasm of accommodation, visual changes
GI: Cramps, diarrhea, dysphagia, flatulence, increased gastric secretions, increased peristalsis, increased salivation, nausea, vomiting
GU: Frequency, incontinence, urgency
MS: Arthralgia, fasciculation, muscle cramps and spasms, weakness
RESP: Bronchospasm, dyspnea, increased secretions, laryngospasm, respiratory arrest, respiratory depression
SKIN: Rash, sweating; urticaria 

Patient And Carer Advice: