Pharmacological action Pyridostigmine bromide
Inhibitor of acetylcholinesterase and pseudocholinesterase. Provides indirect cholinomimetic effect through reversible cholinesterase inhibition and potentiation of endogenous acetylcholine. Improves the neuromuscular transmission, enhances skin tone and peristalsis of the digestive tract, increases the tone of the bladder, bronchus and secretion of exocrine glands. Causes bradycardia.
Pharmacokinetics Pyridostigmine bromide
After oral administration is poorly absorbed from the gastrointestinal tract. In contrast, neostigmine and physostigmine, are not hydrolyzed by cholinesterase. Excreted in urine.
Statement Pyridostigmine bromide
Myasthenia gravis and myasthenic syndrome, postoperative bowel atony, atonic constipation, violations of emptying the bladder after gynecological surgery and childbirth.
Removal of depolarizing not kurarepodobnoe funds.
Dosing regimen Pyridostigmine bromide
If ingestion – by 60-180 mg 2-4 times / day, if necessary, the dose is increased.
Parenteral (subcutaneous, IM or IV) administered at 5 mg up to 5 times per day.
With a view to ending miorelaxation – IV slowly in a dose of 5 mg (sometimes in combination with atropine in a dose of 500 mcg). In some cases, the dose is distributed into 2 injection.
Side effect Pyridostigmine bromide
Cardio-vascular: bradycardia.
From the digestive system: nausea, vomiting, diarrhea, stomach cramps, increased salivation.
CNS: muscle twitching, muscle weakness, miosis.
From the respiratory system: an increase in tone and bronchial secretions.
Allergic reactions: skin rash.
Contraindications Pyridostigmine bromide
Mechanical obstruction of the bowel or urinary tract, bronchial asthma, increased sensitivity to Pyridostigmine bromide.
Application of pregnancy and breastfeeding Pyridostigmine bromide
Application of pregnancy and lactation is possible only under strict indications.
Cautions Pyridostigmine bromide
In patients with gastric ulcer, hyperthyroidism, heart failure in a phase of decompensation and myocardial infarction Pyridostigmine bromide is used only after careful comparison of the risk of side effects and the expected beneficial effect. Particular caution should be used in patients with bradycardia, diabetes, kidney disease, Parkinson’s disease, past illnesses of the liver, as well as after operations on the gastrointestinal tract.
Recommended to choose the time of receipt Pyridostigmine bromide so that its maximum effect coincided with the cycle of physical activity the patient. It should be remembered that the absence of expected response to treatment may be due to an overdose.
Effects on ability to drive vehicles and management mechanisms
In applying Pyridostigmine bromide should avoid driving and other activities requiring a high concentration, rapid psychomotor reactions.
Drug Interactions Pyridostigmine bromide
Pyridostigmine bromide is an antagonist of nondepolarizing muscle relaxants and enhances the action of depolarizing muscle relaxants.
M-holinoblokatory, ganglioplegic, quinidine, novokainamid, local anesthetics, tricyclic antidepressants, antiepileptic and antiparkinsonian drugs reduce the effect of Pyridostigmine bromide.
Atropine is able to neutralize M-cholinergic action of Pyridostigmine (but not its effect on skeletal muscle).
Pyridostigmine bromide may exacerbate the effects of derivatives of morphine and barbiturates.
