Pyridostigmine is a cholinesterase inhibitor leading to prolongation of ACh action.This enhances neuromuscular transmission in voluntary and involuntary muscle in myasthenia gravis.
Uses
Myasthenia gravis
Administration
• Orally: 60–240 mg 4–6 hourly (maximum daily dose: 1.2 g)
When relatively large doses are taken it may be necessary to give atropine or other anticholinergic drugs to counteract the muscarinic effects
Contraindications
Bowel obstruction
Urinary obstruction
How not to use pyridostigmine
Excessive dosage may impair neuromuscular transmission and precipitates ‘cholinergic crises’ by causing a depolarising block. It is inadvisable to exceed a daily dose of 720mg
Adverse effects
Increased sweating
Excess salivation
Nausea and vomiting
Abdominal cramp
Diarrhoea
Bradycardia
Hypotension
These muscarinic side-effects are antagonised by atropine
Cautions
Asthma
Organ failure
Renal: reduce dose
Renal replacement therapy
No further dose modification is required during renal replacement therapy
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