Pyridostigmine (Mestinon)
7
- Usual doses
- Adults
- Pills
- 60 mg tid to 120 mg q3h
- Higher does
- Virtually never effective
- Often have side effects
- Timespan pills
- 90 to 180 mg qhs
- Use only at bedtime
- Many cholinergic side effects if used more often than qhs
- Liquid: 60 mg pyridostigmine bromide per teaspoonful (5 mL)
- Childhood: Anti-AChE drugs
- Indications
- Autoimmune MG
- Most AChR Ab+ patients: First line treatment
- MuSK Ab+ patients: Often less helpful
- Congenital MG: Some syndromes
- Fatigue syndromes without MG: 30 mg 2x to 3x per day
- Orthostatic hypotension: With spared peripheral noradrenergic axons
6
- Advantages
- Rapid onset of benefit
- Few serious side effects
- Inexpensive
- May be discontinued when immunomodulation becomes effective
- Disadvantages
- Cholinergic symptoms & crisis: Especially with timespan tablets
- Effective in only some patients
- Less complete benefit: Severe MG; Ocular MG
- Comparison to corticosteroids or other immunomodulating agent treatment
- Often less effective over long term
- More likelihood of MG relapse when given alone
- Other Management: Do not use tensilon to gauge pyridostigmine dosing
- External link: 1935 Anti-AChE Rx (YouTube)
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