Pyridostigmine bromide

May be taken with or without food. ER tab: Swallow whole & do not break/crush/chew. Oral soln: For patients w/ difficulty swallowing, may be administered via feeding tubes. Consult product literature for specific recommendations.

Mechanical gastrointestinal or urinary obstruction.

Patient with bradycardia or cardiac arrhythmia, recent coronary occlusion, hypotension, vagotonia; bronchial asthma, COPD; epilepsy or parkinsonism, hyperthyroidism, peptic ulcer, glaucoma, bromide sensitivity. Requirement for pyridostigmine bromide may be reduced following thymectomy. Renal impairment. Neonates, children, and elderly. Pregnancy and lactation. Patient Counselling This drug may impair visual acuity and consequently affect the ability to react, if affected, do not drive or operate machinery. Monitoring Parameters Monitor blood pressure and heart rate and obtain ECG, especially with IV use. Assess for signs and symptoms of cholinergic reactions (e.g. nausea, vomiting, diarrhoea, increased salivation), particularly when administered via IV.

Significant: Hypersensitivity reactions, cardiac effects (e.g. bradycardia, syncope, AV block), gastrointestinal effects (e.g. abdominal cramps, increased peristalsis, sialorrhoea, diarrhoea, nausea, vomiting), respiratory effects (e.g. increased bronchial secretions, bronchoconstriction). Eye disorders: Miosis, increased lacrimation, accommodation disorders (e.g. blurred vision). Musculoskeletal and connective tissue disorders: Fasciculation, muscle cramps, muscle hypotonia, increased muscle weakness. Nervous system disorders: Tremors. Renal and urinary disorders: Urinary urgency. Skin and subcutaneous tissue disorders: Rash, hyperhidrosis. Vascular disorders: Hypotension.

Requirement for pyridostigmine bromide may be reduced with corticosteroids and immunosuppressant drugs. Antagonised muscarinic effect with atropine and hyoscine. Pyridostigmine bromide antagonises the effect of nondepolarising muscle relaxants (e.g. pancuronium bromide, vecuronium bromide). May prolong the effect of depolarising muscle relaxants (e.g. suxamethonium). May enhance the bradycardic effect of β-blockers. May cause or exacerbate night vision problems with antiglaucoma agents.

Antidotes, Detoxifying Agents & Drugs Used in Substance Dependence / Neuromuscular Disorder Drugs / Other Drugs Acting on the Genito-Urinary System