Mestinon (pyridostigmine bromide)
Treatment of myasthenia gravis.
Usual: Ten 60mg tabs or ten 5mL tsp daily, spaced to provide max relief
Mild Cases: 1-6 tabs or tsp/day may suffice
Severe Cases: May require as many as 25 tabs or tsp/day
One-three 180mg tabs qd or bid
Dosing interval should be at least 6 hrs
For optimum control, use w/ the more rapidly acting regular tabs or syrup may be necessary
Syrup: 60mg/5mL [473mL]; Tab: 60mg*; Tab, Extended-Release (ER): (Timespan) 180mg* *scored
Mechanical intestinal or urinary obstruction.
Caution with bronchial asthma. Although failure to show clinical improvement may reflect underdosage, this can also be indicative of overdosage. Increasing/extreme muscle weakness occurs with cholinergic crisis and myasthenic crisis; caution in distinguishing between the 2 conditions. Lower doses may be required with renal disease; treatment should be based on titration of drug dosage to effect.
N/V, diarrhea, abdominal cramps, increased peristalsis, increased salivation, increased bronchial secretions, miosis, diaphoresis, muscle cramps, fasciculation, weakness.
Atropine may mask signs of overdosage when used counteract side effects, which can lead to inadvertent induction of cholinergic crisis.
PREGNANCY AND LACTATION
Safety not known in pregnancy/nursing.
MECHANISM OF ACTION
Cholinesterase inhibitor; inhibits the destruction of acetylcholine by cholinesterase and thereby permits free transmission of nerve impulses across the neuromuscular junction.
Elimination: Urine (unchanged).
Assess for mechanical intestinal/urinary obstruction, bronchial asthma, renal disease, pregnancy/nursing status, and possible drug interactions.
Monitor clinical improvement and for adverse reactions.
Inform of the risks and benefits of therapy. Instruct to report any adverse reactions.
25°C (77°F); excursions permitted to 15-30°C (59-86°F). (Tab/Tab, ER) Keep in a dry place with silica gel enclosed.
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