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AHFS Consumer Medication Information [Internet]. Bethesda (MD): American Society of Health-System Pharmacists; 2000-2011.

AHFS Consumer Medication Information [Internet].

Pyridostigmine(peer id oh stig' meen)

Last reviewed: September 1, 2010.

Why is this medication prescribed?

Pyridostigmine is used to decrease muscle weakness resulting from myasthenia gravis.

This medication is sometimes prescribed for other uses; ask your doctor or pharmacist for more information.

How should this medicine be used?

Pyridostigmine comes as a regular tablet, an extended-release (long-acting) tablet, and a syrup to take by mouth. It usually is taken once, twice, or several times a day, depending on the type of tablet. Your doctor may change your dose, depending on how you respond to the drug. When you first start taking pyridostigmine, your doctor may want you to keep a daily record of the time you take each dose, how long you feel better after taking each dose, and if you have side effects. This record will help the doctor decide how much drug is best for you.

Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take pyridostigmine exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor.

Continue to take pyridostigmine even if you feel well. Do not stop taking pyridostigmine without talking to your doctor.

Pyridostigmine overdose can cause severe illness, including muscle weakness. It is very hard to tell the difference between too little and too much pyridostigmine. Call your doctor immediately if your symptoms become worse.

What special precautions should I follow?

Before taking pyridostigmine,

  • tell your doctor and pharmacist if you are allergic to pyridostigmine, bromides, or any other drugs.

  • tell your doctor and pharmacist what prescription and nonprescription medications you are taking, especially allergy or cold medications, dexamethasone (Decadron), hydrocortisone (Hydrocortone), magnesium-containing products, medications for heart arrhythmias, sleeping pills, and vitamins.

  • tell your doctor if you have or have ever had intestinal or bladder blockage, asthma, seizures, heart or kidney disease, thyroid problems, or stomach ulcers.

  • tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. If you become pregnant while taking pyridostigmine, call your doctor.

  • you should know that this drug may make you drowsy. Do not drive a car or operate machinery until you know how this drug affects you.

  • remember that alcohol can add to the drowsiness caused by this drug.

What special dietary instructions should I follow?

Pyridostigmine may cause an upset stomach. Take pyridostigmine with food or milk.

What should I do if I forget a dose?

Take the missed dose as soon as you remember it. However, if you remember a missed dose near the time you are supposed to take the next dose, take only the regularly scheduled dose. Do not take a double dose to make up for a missed one.

What side effects can this medication cause?

Pyridostigmine may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:

  • upset stomach

  • diarrhea

  • vomiting

  • drooling

  • pale skin

  • cold sweats

  • blurred vision

  • watery eyes

  • increased urge to urinate

  • anxiousness and feelings of panic

  • muscle weakness

If you experience any of the following symptoms, call your doctor immediately:

  • severe itching, skin rash, or hives

  • slurred speech

  • confusion

  • seizures

  • difficulty breathing

If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting program online [at http://www.fda.gov/Safety/MedWatch] or by phone [1-800-332-1088].

What storage conditions are needed for this medicine?

Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from excess heat and moisture (not in the bathroom). Throw away any medication that is outdated or no longer needed. Talk to your pharmacist about the proper disposal of your medication.

In case of emergency/overdose

In case of overdose, call your local poison control center at 1-800-222-1222. If the victim has collapsed or is not breathing, call local emergency services at 911.

What other information should I know?

Keep all appointments with your doctor and the laboratory. Your doctor will order certain lab tests to check your response to pyridostigmine.

Do not let anyone else take your medication. Ask your pharmacist any questions you have about refilling your prescription.

It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.

This report on medications is for your information only, and is not considered individual patient advice. Because of the changing nature of drug information, please consult your physician or pharmacist about specific clinical use.

The American Society of Health-System Pharmacists, Inc. represents that the information provided hereunder was formulated with a reasonable standard of care, and in conformity with professional standards in the field. The American Society of Health-System Pharmacists, Inc. makes no representations or warranties, express or implied, including, but not limited to, any implied warranty of merchantability and/or fitness for a particular purpose, with respect to such information and specifically disclaims all such warranties. Users are advised that decisions regarding drug therapy are complex medical decisions requiring the independent, informed decision of an appropriate health care professional, and the information is provided for informational purposes only. The entire monograph for a drug should be reviewed for a thorough understanding of the drug's actions, uses and side effects. The American Society of Health-System Pharmacists, Inc. does not endorse or recommend the use of any drug. The information is not a substitute for medical care.

AHFS® Consumer Medication Information. © Copyright, 2011. The American Society of Health-System Pharmacists, Inc., 7272 Wisconsin Avenue, Bethesda, Maryland. All Rights Reserved. Duplication for commercial use must be authorized by ASHP.

The following brand names are from RxNorm, a standardized nomenclature for clinical drugs produced by the National Library of Medicine:

Brand names

  • Mestinon

What works?

  • Treatment for Lambert‐Eaton myasthenic syndrome Treatment for Lambert‐Eaton myasthenic syndrome
    Lambert‐Eaton myasthenic syndrome (LEMS) is a rare disorder of the neuromuscular junction that causes muscle weakness (most commonly in the upper arms and legs). It is an autoimmune disease in which the body's own antibodies prevent the release of the chemical acetylcholine. This interferes with transmission of nerve impulses to the muscles. One of the main treatments is 3,4‐diaminopyridine which increases the release of acetylcholine. Four small randomised controlled trials involving 54 participants in total showed that 3,4‐diaminopyridine improves muscle strength. This was determined by measuring the compound muscle action potential (CMAP) which is a test that records the amount of electrical activity generated in a muscle when it is stimulated by its nerve. Although the number of trials is relatively small, the quality of evidence from these trials is moderate to high, which supports the findings of this review. The changes are measured over days only. A single trial involving nine participants showed that intravenous immunoglobulin also improved muscle strength up to 8 weeks from treatment. Other possible treatments such as plasma exchange, steroids and immunosuppressive agents have not been tested in randomised controlled trials. Further trials of these treatments are needed.
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Conditions of interest

  • Myasthenia gravis
    Myasthenia gravis is a neuromuscular disorder. Neuromuscular disorders involve the muscles and the nerves that control them.
  • Lambert-Eaton syndrome
    Lambert-Eaton syndrome is a disorder in which faulty communication between nerves and muscles leads to muscle weakness.
  • Hypotension
    Low blood pressure, or hypotension, occurs when blood pressure during and after each heartbeat is much lower than usual. This means the heart, brain, and other parts of the body do not get enough blood.

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