Reversible cholinesterase inhibitor
Pyridostigmine bromide
Brand names: Mestinon
Adult dose
Dose: Myasthenia gravis: initial 30–60mg PO QDS, titrate to symptoms; usual 60–120mg every 4–6h (max 1.2g/day)
Route: PO
Frequency: q4-6h
Clinical pearls
- Myasthenia gravis — first-line symptomatic
- Cholinergic crisis vs myasthenic crisis: edrophonium test (specialist)
Contraindications
- GI/urinary obstruction
- Severe asthma
- Hypersensitivity
Side effects
- Cholinergic effects (cramps, diarrhoea, salivation, lacrimation, miosis)
- Bradycardia
- Bronchospasm
- Cholinergic crisis (overdose)
Interactions
- Aminoglycosides
- β-blockers
- Atropine (antagonist)
- Suxamethonium
Monitoring
- Symptoms
- Muscle strength
Reference: BNF; ABN guidelines; https://bnf.nice.org.uk/drugs/pyridostigmine-bromide/. Verify against your local formulary and the latest BNF before prescribing.
Related
Curated clinical cross-links plus same-class fallbacks.
Calculators
- SMART Risk Score for Recurrent CVD · Cardiovascular Risk
- PCSK9 Inhibitor Eligibility Assessment · Lipid Management
- Immune-Related Adverse Events (irAE) -- GI Toxicity Colitis Grading · Oncology-Related GI
- irAE Hepatitis Grading (CTCAE) · Immunotherapy
- DIPSS — Dynamic International Prognostic Scoring System for Myelofibrosis · Cancer Prognosis
- BALL Score for Relapsed/Refractory CLL · Leukaemia
Pathways
- Acute Stroke / TIA Assessment · NICE NG128; RCP Stroke Guidelines 2023
- Status Epilepticus (Adults) · NICE CG137; ESEM guidelines; RCP Neurology Guidelines
- Suspected Subarachnoid Haemorrhage · NICE NG228; RCEM 2023; AHA/ASA 2023
- Adult Head Injury · NICE NG232 (2023)
- Bell's Palsy / Facial Nerve Palsy · ENT UK 2017; AAN
- Vertigo Workup · ENT UK; NICE CKS