Pyridostigmine

Not to be confused with Physostigmine.
Pyridostigmine
Clinical data
Trade namesMestinon, others
AHFS/Drugs.comMonograph
MedlinePlusa682229
Pregnancy
category
  • AU: C
Routes of
administration		By mouth, intravenous
Drug classAcetylcholinesterase inhibitor; Parasympathomimetic
ATC code
Legal status
Legal status
Pharmacokinetic data
Bioavailability7.6 ± 2.4%
Elimination half-life1.78 ± 0.24 hours
Excretionkidney
Identifiers
  • 3-[(dimethylcarbamoyl)oxy]-1-methylpyridinium
CAS Number
PubChem CID
DrugBank
ChemSpider
UNII
KEGG
ChEMBL
CompTox Dashboard (EPA)
Chemical and physical data
FormulaC9H13N2O2
Molar mass181.215 g·mol−1
3D model (JSmol)
  • O=C(Oc1ccc[n+](c1)C)N(C)C
  • InChI=1S/C9H13N2O2/c1-10(2)9(12)13-8-5-4-6-11(3)7-8/h4-7H,1-3H3/q+1 checkY
  • Key:RVOLLAQWKVFTGE-UHFFFAOYSA-N checkY
  (verify)

Pyridostigmine is a medication used to treat myasthenia gravis[1] and underactive bladder.[2] It is also used together with atropine to end the effects of neuromuscular blocking medication of the non-depolarizing type.[3] It is also used off-label to treat some forms of Postural orthostatic tachycardia syndrome. It is typically given by mouth but can also be used by injection.[3] The effects generally begin within 45 minutes and last up to 4 hours.[3]

Common side effects include nausea, diarrhea, frequent urination, and abdominal pain.[3] More severe side effects include low blood pressure, weakness, and allergic reactions.[3] It is unclear if use in pregnancy is safe for the fetus.[3] Pyridostigmine is an acetylcholinesterase inhibitor in the cholinergic family of medications.[3] It works by blocking the action of acetylcholinesterase and therefore increases the levels of acetylcholine.[3]

Pyridostigmine was patented in 1945 and came into medical use in 1955.[4] It is on the World Health Organization's List of Essential Medicines.[5] Pyridostigmine is available as a generic medication.[3][6]

  1. ^ World Health Organization (2009). Stuart MC, Kouimtzi M, Hill SR (eds.). WHO Model Formulary 2008. World Health Organization. p. 429. hdl:10665/44053. ISBN 9789241547659.
  2. ^ Moro C, Phelps C, Veer V, Clark J, Glasziou P, Tikkinen KA, Scott AM (November 2021). "The effectiveness of parasympathomimetics for treating underactive bladder: A systematic review and meta-analysis". Neurourology and Urodynamics. 41 (1): 127–139. doi:10.1002/nau.24839. PMID 34816481. S2CID 244530010.
  3. ^ a b c d e f g h i "Neostigmine Bromide". The American Society of Health-System Pharmacists. Archived from the original on 21 December 2016. Retrieved 8 December 2016.
  4. ^ Fischer J, Ganellin CR (2006). Analogue-based Drug Discovery. John Wiley & Sons. p. 540. ISBN 9783527607495. Archived from the original on 2016-12-20.
  5. ^ World Health Organization (2019). World Health Organization model list of essential medicines: 21st list 2019. Geneva: World Health Organization. hdl:10665/325771. WHO/MVP/EMP/IAU/2019.06. License: CC BY-NC-SA 3.0 IGO.
  6. ^ "Competitive Generic Therapy Approvals". U.S. Food and Drug Administration (FDA). 3 March 2023. Retrieved 6 March 2023.