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Home > Drug Category > Myasthenia Gravis Medication > Mestinon and Equivalent

Mestinon Information

Mestinon (Pyridostigmine) is a potent acetylcholinesterase inhibitor used primarily to improve muscle strength in patients with myasthenia gravis, especially helping with muscle weakness presenting as swallowing, speaking, and droopy eyelids. Additionally, it can treat paralytic ileus, a condition in which the intestine stops contracting and moving its contents (provided there is no physical obstruction). Mestinon is also used in managing postoperative urinary retention, a condition in which you are unable to urinate after having surgery. Furthermore, it can be used in the military as a protective measure against the effects of certain nerve agents called Soman nerve gas before potential exposure.

Pyridostigmine works by blocking acetylcholinesterase, an enzyme that breaks down acetylcholine (a neurotransmitter). This neurotransmitter transmits signals between nerves and muscles, enabling muscle movement. By blocking the effects of this enzyme, this medication allows acetylcholine to build up and linger longer in the gap between nerves and muscles. This increased accumulation gives the chemical more time to bind to muscle receptors, thereby strengthening the signals, improving muscle contraction, and relieving symptoms associated with myasthenia gravis, paralytic ileus, and other conditions. This medication carries a specific positive electrical charge (as a quaternary ammonium compound), so its effects are restricted to the body's peripheral muscles rather than the brain, as it cannot easily cross the blood-brain barrier.

Mestinon Side Effects

Relatively common but mild side effects of this medication include nausea, vomiting, diarrhea, stomach cramps, and increased saliva production. Contact your doctor if these mild side effects persist or worsen.

Consult your doctor as soon as possible or seek urgent medical attention if you notice the following serious side effects:
• Allergic reactions such as breathing difficulties, body itching, body rash, skin blistering, swelling of the face, mouth, tongue, lips, or throat;
• Excessive sweating;
• Feeling faint;
• Increased muscle weakness (which may indicate a dangerous overdose known as a cholinergic crisis);
• Muscle cramps or twitching (fasciculations);
• Slowed heart rate (bradycardia)

Additionally, inform your doctor about any other side effects not listed here.

Mestinon Precautions

Do not use this medication if you have:
• An allergy to pyridostigmine bromide, other ingredients in this medication, or any other medication;
• A mechanical blockage in the intestines.
• A mechanical blockage in the urinary tract.

For certain underlying health conditions, pyridostigmine need not be avoided entirely. Still, it should be used with careful monitoring and at lower doses. Therefore, before using this medication, ensure you inform your doctor about any medical conditions you previously or currently have, especially the following:
• Breathing problems such as asthma and bronchitis;
• Epilepsy or seizure disorders;
• Heart disease or a slow heart rate;
• Kidney disease;
• Low blood pressure;
• Peptic ulcers;
• Parkinson's disease;
• Thyroid problems, such as an overactive thyroid gland

Medications such as gentamicin, neomycin, and tobramycin (aminoglycoside antibiotics) have a mild neuromuscular-blocking side effect that can exacerbate muscle weakness and counter the therapeutic effects of pyridostigmine. Also, some other medications like hyoscine, glycopyrronium, and certain older antihistamines or tricyclic antidepressants work by blocking acetylcholine (anticholinergics) and thus can reduce the effectiveness of pyridostigmine. Therefore, it is important to inform your doctor about any other medications you are currently taking, including herbal products and supplements, to determine whether they are safe to use with pyridostigmine.

Consult your doctor before using this medication if you are pregnant or planning to become pregnant. While it is typically the preferred choice for managing myasthenia gravis during pregnancy because it does not easily cross the placenta, your doctor will still want to monitor your dosage closely. Likewise, do not use this medication while breastfeeding unless recommended by your doctor, as a very small amount of this medication can still pass through breastmilk. Store Mestinon in a cool, dry place, out of reach of children and pets.

Do I need a prescription to order Mestinon?

Yes, a prescription is required from your physician to order Mestinon.