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| {{DrugProjectFormSinglePage
| | #redirect:[[Pyridostigmine]] |
| |authorTag={{AP}}
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| |genericName=Pyridostigmine
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| |aOrAn=a
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| |drugClass=[[cholinesterase inhibitor]]
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| |indication=[[myasthenia gravis]]
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| |adverseReactions=[[diaphoresis]], [[diarrhea]], [[excessive salivation]], increased peristalsis, [[nausea and vomiting]], [[stomach cramps]], [[muscle fasciculation]], [[asthenia]], [[miosis]] and excessive [[bronchial secretion]]
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| |blackBoxWarningTitle=<b><span style="color:#FF0000;">TITLE</span></b>
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| |blackBoxWarningBody=<i><span style="color:#FF0000;">Condition Name:</span></i> (Content)
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| |fdaLIADAdult======Myasthenia Gravis=====
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| Pyridostigmine bromide is available in tablets, each containing 60 mg pyridostigmine bromide.
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| *Dosage: The size and frequency of the dosage must be adjusted to the needs of the individual patient. The average dose is ten 60-mg tablets daily, spaced to provide maximum relief when maximum strength is needed. In severe cases as many as 25 tablets a day may be required, while in mild cases one to six tablets a day may suffice.
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| |offLabelAdultGuideSupport=There is limited information regarding <i>Off-Label Guideline-Supported Use</i> of Pyridostigmine (patient information) in adult patients.
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| |offLabelAdultNoGuideSupport======Prophylaxis of Organophosphate Poisoning=====
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| *Dosage: 30 mg q8h<ref name="pmid2072481">{{cite journal| author=Keeler JR, Hurst CG, Dunn MA| title=Pyridostigmine used as a nerve agent pretreatment under wartime conditions. | journal=JAMA | year= 1991 | volume= 266 | issue= 5 | pages= 693-5 | pmid=2072481 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2072481 }} </ref>
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| |fdaLIADPed======Myasthenia Gravis=====
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| Pyridostigmine bromide is available in tablets, each containing 60 mg pyridostigmine bromide.
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| *Dosage: The size and frequency of the dosage must be adjusted to the needs of the individual patient. The average dose is ten 60-mg tablets daily, spaced to provide maximum relief when maximum strength is needed. In severe cases as many as 25 tablets a day may be required, while in mild cases one to six tablets a day may suffice.
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| |offLabelPedGuideSupport=There is limited information regarding <i>Off-Label Guideline-Supported Use</i> of Pyridostigmine (patient information) in pediatric patients.
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| |offLabelPedNoGuideSupport=There is limited information regarding <i>Off-Label Non–Guideline-Supported Use</i> of Pyridostigmine (patient information) in pediatric patients.
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| |contraindications=Pyridostigmine bromide is contraindicated in mechanical intestinal or [[urinary obstruction]], and particular caution should be used in its administration to patients with [[bronchial asthma]]. Care should be observed in the use of [[atropine]] for counteracting side effects, as discussed below.
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| |warnings=Although failure of patients to show clinical improvement may reflect underdosage, it can also be indicative of [[overdosage]]. As is true of all [[cholinergic drugs]], overdosage of pyridostigmine bromide may result in [[cholinergic crisis]], a state characterized by increasing [[muscle weakness]] which, through involvement of the muscles of respiration, may lead to death. [[Myasthenic crisis]] due to an increase in the severity of the disease is also accompanied by extreme [[muscle weakness]], and thus may be difficult to distinguish from [[cholinergic crisis]] on a symptomatic basis. Such differentiation is extremely important, since increases in doses of pyridostigmine bromide or other drugs of this class in the presence of cholinergic crisis or of a refractory or "insensitive" state could have grave consequences. Osserman and Genkins indicate that the differential diagnosis of the two types of crisis may require the use of [[Tensilon]] ([[edrophonium chloride]]) as well as clinical judgment. The treatment of the two conditions obviously differs radically. Whereas the presence of myasthenic crisis suggests the need for more intensive anticholinesterase therapy, the diagnosis of cholinergic crisis, according to Osserman and Genkins, calls for the prompt withdrawal of all drugs of this type. The immediate use of [[atropine]] in [[cholinergic crisis]] is also recommended.
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| [[Atropine]] may also be used to abolish or obtund gastrointestinal side effects or other [[muscarinic]] reactions; but such use, by masking signs of overdosage, can lead to inadvertent induction of [[cholinergic crisis]]. For detailed information on the management of patients with [[myasthenia gravis]], the physician is referred to one of the excellent reviews such as those by Osserman and Genkins, Grob or Schwab.
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| |clinicalTrials=The side effects of pyridostigmine bromide are most commonly related to overdosage and generally are of two varieties, [[muscarinic]] and [[nicotinic]]. Among those in the former group are [[nausea]], [[vomiting]], [[diarrhea]], abdominal [[cramps]], increased [[peristalsis]], increased [[salivation]], increased bronchial [[secretions]], [[miosis]] and [[diaphoresis]]. [[Nicotinic]] side effects are comprised chiefly of [[muscle cramps]], [[fasciculation]] and [[weakness]]. [[Muscarinic]] side effects can usually be counteracted by [[atropine]], but for reasons shown in the preceding section the expedient is not without danger. As with any compound containing the [[bromide radical]], a skin [[rash]] may be seen in an occasional patient. Such reactions usually subside promptly upon discontinuance of the medication.
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| |FDAPregCat=C
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| |useInPregnancyFDA=The safety of pyridostigmine bromide during pregnancy or lactation in humans has not been established. Therefore, use of pyridostigmine bromide in women who may become pregnant requires weighing the drug's potential benefits against its possible hazards to mother and child.
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| |AUSPregCat=C
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| |useInPed=Safety and effectiveness in pediatric patients have not been established.
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| |administration=*Pyridostigmine bromide is available in tablets, each containing 60 mg pyridostigmine bromide.
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| |drugBox={{Drugbox2
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| | verifiedrevid = 464377022
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| | IUPAC_name = 3-[(dimethylcarbamoyl)oxy]-1-methylpyridinium
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| | image = Pyridostigmine Structure.png
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| <!--Clinical data-->
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| | tradename = Mestinon
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| | Drugs.com = {{drugs.com|monograph|pyridostigmine-bromide}}
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| | MedlinePlus = a682229
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| | pregnancy_AU = C
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| | pregnancy_US = C
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| | legal_UK = POM
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| | legal_US = Rx-only
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| | routes_of_administration = Oral, [[Intravenous therapy|intravenous]]
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| | |
| <!--Pharmacokinetic data-->
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| | bioavailability = 7.6 +/- 2.4%
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| | protein_bound =
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| | metabolism =
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| | elimination_half-life = 1.78 +/- 0.24hrs
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| | excretion = [[Kidney|Renal]]
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| <!--Identifiers-->
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| | CASNo_Ref = {{cascite|correct|CAS}}
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| | CAS_number_Ref = {{cascite|correct|??}}
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| | CAS_number = 155-97-5
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| | ATC_prefix = N07
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| | ATC_suffix = AA02
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| | ATC_supplemental =
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| | PubChem = 4991
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| | DrugBank_Ref = {{drugbankcite|correct|drugbank}}
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| | DrugBank = DB00545
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| | ChemSpiderID_Ref = {{chemspidercite|correct|chemspider}}
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| | ChemSpiderID = 4817
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| | UNII_Ref = {{fdacite|correct|FDA}}
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| | UNII = 19QM69HH21
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| | KEGG_Ref = {{keggcite|correct|kegg}}
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| | KEGG = D00487
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| | ChEMBL_Ref = {{ebicite|correct|EBI}}
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| | ChEMBL = 1115
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| <!--Chemical data-->
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| | C=9 | H=13 | N=2 | O=2
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| | molecular_weight = 181.212 g/mol
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| | smiles = O=C(Oc1ccc[n+](c1)C)N(C)C
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| | InChI = 1/C9H13N2O2/c1-10(2)9(12)13-8-5-4-6-11(3)7-8/h4-7H,1-3H3/q+1
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| | InChIKey = RVOLLAQWKVFTGE-UHFFFAOYAK
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| | StdInChI_Ref = {{stdinchicite|correct|chemspider}}
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| | StdInChI = 1S/C9H13N2O2/c1-10(2)9(12)13-8-5-4-6-11(3)7-8/h4-7H,1-3H3/q+1
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| | StdInChIKey_Ref = {{stdinchicite|correct|chemspider}}
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| | StdInChIKey = RVOLLAQWKVFTGE-UHFFFAOYSA-N
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| }}
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| |mechAction=Pyridostigmine bromide inhibits the destruction of acetylcholine by cholinesterase and thereby permits freer transmission of nerve impulses across the neuromuscular junction.
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| |structure=Chemically, pyridostigmine bromide is 3-hydroxy-1-methylpyridinium bromide dimethylcarbamate. Its structural formula is:
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| [[file:Pyridostigmine Structure.png|none|300px]]
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| |PD=Pyridostigmine is an analog of neostigmine (Prostigmin®), but differs from it in certain clinically significant respects; for example, pyridostigmine is characterized by a longer duration of action and fewer gastrointestinal side effects.
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| |howSupplied=[[file:Pyridostigmine How Supplied.png|none|300px]]
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| |packLabel=[[file:Pyridostigmine Label.png|none|350px]]
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| |alcohol=Alcohol-Pyridostigmine (patient information) interaction has not been established. Talk to your doctor about the effects of taking alcohol with this medication.
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| |brandNames=*[[Mestinon]]
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| *[[Mestinon]]
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| *[[Timespan]]
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| *[[Regonol]]
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| }}
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| {{LabelImage
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| |fileName=Pyridostigmine Package.png
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| }}
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