Pyridostigmine

Can cause excess Ach with a Cholinergic crisis/syndrome. Avoid with asthma

About: Always check the BNF link here

• Useful for those who are weak on waking

Mode of action

• Less potent than neostigmine but longer action
• Inhibit action of acetylcholinesterase which prolongs the action of Ach
• In excess can impair action and worsen weakness
• It can precipitate cholinergic crises by causing a depolarising block.
• This may be difficult to distinguish from a worsening myasthenic state.

Dose range: Monitor LFTs

Interactions

• See BNF

Cautions

• Asthma (extreme caution), bradycardia, arrhythmias, recent MI
• Epilepsy, hypotension, parkinsonism, peptic ulceration, hyperthyroidism

Contraindications

• Bowel/Urinary obstruction

Side effects

• Pronounced muscarinic action - sweating, colic, excessive salivation, or diarrhoea, excess gastric secretions, bradycardia.
• Can be reverse with Atropine like drugs.

References