Pyridostigmine
Pyridostigmine is a cholinesterase inhibitor that works by preventing the breakdown of acetylcholine, a neurotransmitter essential for nerve signal transmission to muscles. It is primarily used to treat myasthenia gravis, a chronic autoimmune disorder causing muscle weakness, and may also be prescribed for orthostatic hypotension.
Pyridostigmine is a cholinesterase inhibitor used to treat myasthenia gravis and muscle weakness by increasing acetylcholine levels at nerve-muscle junctions.
Key facts at a glance
- ATC
- N07AA02
- RxNorm
- 9000
- Generic
- Pyridostigmine
- Class
- atc-n07
- Brands
- Mestinon, Regonol
- Availability
- rx
- Lactation
- unknown
- Routes
- oral
- Forms
- injection, tablet, solution
- Regions
- US, EU, CN, JP
- Monitoring
- —
This page is for informational purposes only.
Do not use this information to diagnose yourself or to replace a physician's advice. Always consult a qualified healthcare provider before starting, stopping, or changing any medication. If you believe you are experiencing a medical emergency, call your local emergency number immediately.
Dosage and administration
- Usual dose
- 60mg 3-4 times daily
- Maximum
- consult physician
- Frequency
- every 6-8 hours
- Instructions
- Follow physician instructions
- Duration limits
- as prescribed
- Monitoring
- standard
- Usual dose
- 1mg/kg/dose
- Maximum
- consult physician
- Frequency
- every 6-8 hours
- Instructions
- Follow physician instructions
- Duration limits
- as prescribed
- Monitoring
- standard
- Usual dose
- 30-60mg 3-4 times daily
- Maximum
- consult physician
- Frequency
- every 6-8 hours
- Instructions
- Follow physician instructions
- Duration limits
- as prescribed
- Monitoring
- standard
Overdose information
Special Populations
8 groupspregnancy
first trimesteruse lowest effective dose
avoid use during pregnancy unless benefits clearly outweigh risks
regular fetal monitoring, ultrasound assessments
Use with caution and monitor for adverse effects.
pregnancy
second trimesteruse lowest effective dose
continue only if needed for maternal health, regular obstetric follow-up
fetal growth monitoring, regular check-ups
Use with caution and monitor for adverse effects.
pregnancy
third trimesteruse lowest effective dose
continue only if essential, plan delivery with anesthesiology
fetal monitoring, assessment for neonatal myasthenia
Use with caution and monitor for adverse effects.
lactation
breastfeedingmonitor infant closely
use while breastfeeding only if clearly needed, observe infant for feeding difficulties or weakness
monitor infant for signs of cholinergic excess or muscle weakness
Use with caution and monitor for adverse effects.
geriatric
elderlystart with lower dose, titrate slowly
use with caution due to increased sensitivity, increased risk of bradycardia and hypotension
regular cardiovascular monitoring, blood pressure and heart rate checks
Use with caution and monitor for adverse effects.
pediatric_age
childrenweight-based dosing, 1-2 mg/kg every 4-6 hours
approved for use in pediatric myasthenia gravis, individualize dosing
monitor growth, development, and response to therapy
renal_impairment
moderate to severereduce dose in severe impairment, extend dosing interval
use with caution in renal impairment, adjust dose based on renal function
monitor renal function, watch for cholinergic toxicity
Use with caution and monitor for adverse effects.
hepatic_impairment
moderate to severeuse with caution, may need dose reduction
limited data on hepatic impairment, use cautiously
monitor liver function tests, watch for adverse effects
Use with caution and monitor for adverse effects.
Statistics and clinical data
FDA approval year
Original FDA approval for Pyridostigmine
Drug class
World Health Organization ATC classification system
Primary indication
Main therapeutic use for Pyridostigmine
Mechanism of action
Pharmacological mechanism of action
Pyridostigmine is FDA-approved for the treatment of myasthenia gravis, a condition characterized by fluctuating muscle weakness and fatigue. It may also be used off-label for orthostatic hypotension (low blood pressure upon standing) and to reverse neuromuscular blockade after surgery.
Pyridostigmine inhibits the enzyme acetylcholinesterase, which normally breaks down acetylcholine at the neuromuscular junction. By preventing this breakdown, more acetylcholine accumulates, enhancing communication between nerves and muscles and improving muscle strength and function.
Common side effects include gastrointestinal symptoms (nausea, vomiting, diarrhea, abdominal cramps), excessive salivation, and muscle cramps. It should be used with caution in patients with asthma, bradycardia, or urinary obstruction. Dosage must be carefully individualized, and abrupt discontinuation should be avoided. This medication requires a prescription and should be taken exactly as directed by a healthcare provider.
Contraindications
Conditions and patient states where this medication should be avoided or used with caution.
Do not use (1)
Known allergy to this medication or its components
Use caution (1)
Consult healthcare provider for benefits vs risks assessment
Official drug label
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This information is for educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment.
This content is for general informational and educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the guidance of a qualified healthcare provider with any questions you have about a medical condition, and never disregard professional medical advice or delay seeking it because of something you read here.
If you think you may have a medical emergency, call your local emergency number or go to the nearest emergency department immediately.
Medically reviewed by WellAlly Editorial Team Last reviewed August 24, 2026. · Read our editorial policy