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Pyridostigmine


Presentation

  • There were no significant differences in gender, age, the duration of symptoms before treatment, the dosage of pyridostigmine, and the initial presentations of ptosis or diplopia between the two groups.[ncbi.nlm.nih.gov]
  • We present a brief review of the most common medications and medical conditions known to cause this reaction, but to our knowledge this is the first description of pyridostigmine causing this reaction.[ncbi.nlm.nih.gov]
  • We report a case of a 60-year-old man with a 1-year history of myasthenia gravis treated with pyridostigmine who presented with syncope due to high degree AV block.[ncbi.nlm.nih.gov]
  • While similar types of chemical and physiological stressors are present in the general population, the Gulf War veteran population received these stressors in a short time, with greater intensity, and at a higher percentage exposure than normal for the[ncbi.nlm.nih.gov]
  • We present a case series of children with GI dysmotility managed with oral pyridostigmine.[ncbi.nlm.nih.gov]
Prolonged Bleeding
  • Pyridostigmine (Mestinon), an orally active cholinesterase inhibitor that is commonly used to treat myasthenia gravis has been documented to cause epistaxis and prolonged bleeding after a cut in anectodal reports.[ncbi.nlm.nih.gov]
Nausea
  • This retrospective study compared the effects of sugammadex on post-operative nausea and vomiting (PONV) with those of a pyridostigmine-glycopyrrolate mixture.[ncbi.nlm.nih.gov]
  • The effects generally begin within 45 minutes and last up to 6 hours.Common side effects include nausea, diarrhea, frequent urination, and abdominal pain. More severe side effects include low blood pressure, weakness, and allergic reactions.[en.wikipedia.org]
  • Overdose (cholinergic crisis) symptoms may also include increased respiratory secretions and saliva, bradycardia, nausea, vomiting, cramping, diarrhea, and diaphoresis.[quizlet.com]
  • Adverse effects • Muscarinic—Nausea, vomiting, diarrhoea, abdominal cramps, increased peristalsis, increased salivation, increased bronchial secretions, miosis, diaphoresis; reversed with atropine. • Nicotinic—Muscle cramps, fasciculation and weakness[medical-dictionary.thefreedictionary.com]
  • Headaches, dizziness, nausea, rash, and hair loss were reported in both drug and placebo groups. Diarrhea and abdominal pain were reported in the PB group only (four study participants).[pbs.org]
Diarrhea
  • The effects generally begin within 45 minutes and last up to 6 hours.Common side effects include nausea, diarrhea, frequent urination, and abdominal pain. More severe side effects include low blood pressure, weakness, and allergic reactions.[en.wikipedia.org]
  • Overdose (cholinergic crisis) symptoms may also include increased respiratory secretions and saliva, bradycardia, nausea, vomiting, cramping, diarrhea, and diaphoresis.[quizlet.com]
  • . • Nicotinic—Muscle cramps, fasciculation and weakness. pyridostigmine Mestinon Pharmacology A cholinergic used to manage Pts with myasthenia gravis, including crises Adverse effects salivation, fasciculation, abdominal cramps, diarrhea.[medical-dictionary.thefreedictionary.com]
  • GI: abdominal cramps, nausea, vomiting, diarrhea, excessive salivation, increased peristalsis. Musculoskeletal: muscle cramps, muscle fasciculations. Respiratory: bronchospasm, bronchoconstriction, increased bronchial secretions.[glowm.com]
  • Overdose symptoms may include nausea, vomiting, diarrhea, stomach cramps, sweating, blurred vision, drooling, and weak or shallow breathing. Worsening muscle weakness, or no change in your myasthenia gravis symptoms, may also be signs of overdose.[everydayhealth.com]
Failure to Thrive
  • Patients' diagnoses include chronic intestinal pseudo-obstruction, gastroparesis with delayed small bowel transit, chronic constipation with failure to thrive, and prolonged ileus after pelvic surgery with chronic opioid use.[ncbi.nlm.nih.gov]
Orthostatic Hypotension
  • Pyridostigmine treatment trial in neurogenic orthostatic hypotension. Arch Neurol 2006 ;63: 513 – 8. Google Scholar Crossref Medline 14. Sandroni, P Opfer-Gehrking, TL Singer, W Low, PA.[oadoi.org]
  • Pyridostigmine treatment trial in neurogenic orthostatic hypotension . Arch Neurol 2006 ;63: 513 – 8 . Google Scholar Crossref Medline 14. Sandroni, P Opfer-Gehrking, TL Singer, W Low, PA .[doi.org]
  • MEDLINE and International Pharmaceutical Abstracts were searched (1966-December 2006) using the terms pyridostigmine, acetylcholinesterase inhibitor, orthostatic intolerance, orthostatic hypotension, neurogenic orthostatic hypotension, postural tachycardia[ncbi.nlm.nih.gov]
Excessive Tearing
  • Overdose and treatment Toxicity may cause nausea, vomiting, diarrhea, blurred vision, miosis, excessive tearing, bronchospasm, increased bronchial secretions, hypotension, incoordination, excessive sweating, muscle weakness, cramps, fasciculations, paralysis[glowm.com]
Epistaxis
  • Pyridostigmine (Mestinon), an orally active cholinesterase inhibitor that is commonly used to treat myasthenia gravis has been documented to cause epistaxis and prolonged bleeding after a cut in anectodal reports.[ncbi.nlm.nih.gov]
Dysmenorrhea
  • (See Renal Impairment under Dosage and Administration.) 109 111 Common Adverse Effects Diarrhea, 111 abdominal pain or cramps, 111 116 dysmenorrhea, 111 increased flatus, 116 nausea, 116 urinary urgency and frequency. 116 Interactions for Pyridostigmine[drugs.com]
Headache
  • However, evidence suggested that PB could be associated with the Gulf War Illness characterised by the presence of fatigue, headaches, cognitive dysfunction, and musculoskeletal respiratory and gastrointestinal disturbances.[ncbi.nlm.nih.gov]
  • Headaches, dizziness, nausea, rash, and hair loss were reported in both drug and placebo groups. Diarrhea and abdominal pain were reported in the PB group only (four study participants).[pbs.org]
  • Adverse reactions CNS: headache (with high doses), weakness. CV: bradycardia, hypotension, thrombophlebitis. EENT: miosis. GI: abdominal cramps, nausea, vomiting, diarrhea, excessive salivation, increased peristalsis.[glowm.com]
  • William Qubty and Sita Kedia , Dizziness and Orthostatic Intolerance In Pediatric Headache Patients , Seminars in Pediatric Neurology , 10.1016/j.spen.2016.01.004 , 23 , 1 , (71-78) , (2016) .[doi.org]
  • William Qubty and Sita Kedia, Dizziness and Orthostatic Intolerance In Pediatric Headache Patients, Seminars in Pediatric Neurology, 10.1016/j.spen.2016.01.004, 23, 1, (71-78), (2016).[doi.org]

Treatment

  • Available therapies include oral acetylcholinesterase (AChE) inhibitors for symptomatic treatment, and short- and long-term disease-modifying treatments. This review focuses on treatment of MG, mainly on the use of the AChE inhibitor pyridostigmine.[ncbi.nlm.nih.gov]
  • Blood pressure (BP) and heart rate were measured, both supine and standing, immediately before treatment and hourly for 6 hours after the treatment was given.[ncbi.nlm.nih.gov]
  • IPPSFs (n 4/treatment) were topically dosed with mixtures of permethrin, DEET, and permethrin/DEET, in ethanol. Each treatment was repeated with perfusate spiked with 50 ng/ml of PB.[ncbi.nlm.nih.gov]
  • Treatment of myasthenia gravis frequently involves the use of cholinesterase inhibitors such as pyridostigmine. Treatment with these agents has been associated with bradycardia and syncope requiring pacemaker implantation.[ncbi.nlm.nih.gov]
  • CONCLUSION: In patients with slow transit constipation, treatment with pyridostigmine does not improve symptoms.[ncbi.nlm.nih.gov]

Etiology

  • RATIONALE: Questions have been raised about the role pyridostigmine bromide (PB) plays in the etiology of Gulf War veterans' illnesses.[ncbi.nlm.nih.gov]

Epidemiology

  • Many epidemiological studies reported a link between AChEi exposure and chronic symptoms in GWV.[ncbi.nlm.nih.gov]
Sex distribution
Age distribution

Pathophysiology

  • The elusive pathophysiology of neurally mediated syncope . Circulation 2000 ;102: 2898 – 906 . Google Scholar Crossref Medline ISI 4. Bloomfield, DM Sheldon, R Grubb, BP Calkins, H Sutton, R .[doi.org]
  • The elusive pathophysiology of neurally mediated syncope. Circulation 2000 ;102: 2898 – 906. Google Scholar Crossref Medline ISI 4. Bloomfield, DM Sheldon, R Grubb, BP Calkins, H Sutton, R.[doi.org]
  • CONCLUSIONS: Patients with NUD may have a pathophysiological disturbance involving central cholinergic systems.[ncbi.nlm.nih.gov]

Prevention

  • This may be an opportunity to learn the cause, how to prevent, and, possibly, how to treat these ailments in Gulf War veterans and in the general population.[ncbi.nlm.nih.gov]
  • Pyridostigmine prevents the breakdown of acetylcholine at the neuromuscular junction, thus making more neurotransmitter available for the muscles.[ncbi.nlm.nih.gov]
  • To prevent constant stimulation once the ACh is released, an enzyme called acetylcholinesterase is present in the endplate membrane close to the receptors on the post synaptic membrane, and quickly hydrolyses ACh.[en.wikipedia.org]
  • Increase in parasympathetic tone by pyridostigmine prevents ventricular dysfunction during the onset of heart failure. Am J Physiol Regul Integr Comp Physiol 305 :R908-16 (2013).[abcam.com]
  • This condition is characterized by weakness and rapid fatigue of the muscles under voluntary control because communication between nerve cells and muscle cells is deficient, which prevents muscles from contracting.[inhousepharmacy.vu]

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