Mestinon (Pyridostigmine)

Prescription Required.

Product of Canada.

Express Ships from Canada.

Prescription Required.
Product of Canada.
Express Ships from Canada.

What is Mestinon (Pyridostigmine)?

Mestinon (pyridostigmine) is an acetylcholinesterase inhibitor medication that is most commonly prescribed for the treatment of symptoms associated with myasthenia gravis. It may be used by itself or alongside additional medications for treatment. This medication may also be used as a pretreatment for individuals exposed to nerve gas as well as to reverse the effects of certain muscle relaxants.

How is Mestinon Used?

Mestinon is available in tablet form and should be taken orally as instructed by the patient’s doctor. Patients should take only the exact dosage prescribed by their physician.

The tablets should not be broken, chewed, or crushed, and they should only be swallowed whole. If patients taking this medication experience an upset stomach, it may be taken with milk or with food to reduce the likelihood of any digestive disturbances.

The timing when using this medication is a significant factor regarding the efficacy of Mestinon in treating the patient’s symptoms. Individuals using this medication should take their doses at the exact time as instructed by their prescribing physician to ensure the best possible outcome in managing their symptoms.

Additionally, based on the patient’s response to treatment, their physician may also modify their dose as needed to ensure maximum safety and efficacy.

Storage

Mestinon should be stored in its original container, which contains a preservative canister to absorb moisture and protect the medication from any moisture-related damage. It is essential that this medicine remains dry and away from any humidity or damp conditions, and it also must avoid being exposed to any significant sources of heat or high temperatures. It should be kept at room temperature.

Keep this medication out of the reach of children at all times.

Uses

Mestinon is prescribed for use in managing the following conditions:

  • myasthenia gravis
  • pretreatment for exposure to nerve agents
  • the reversal of non-depolarizing muscle relaxants

Mestinon comes in two forms

Customer precautions

Do not take this medication if you have an allergy to Pyridostigmine or any ingredients in this Mestinon.

Speak to your doctor about any of your past or existing medical conditions, especially if you have:

  • asthma or COPD
  • intestinal/stomach blockage
  • kidney or lung disease
  • urinary blockage
  • slow/irregular heartbeat
  • diabetes

Notify your doctor of any other medications, supplements, herbal medicines or vitamins you are currently taking.

Consult your doctor if you are pregnant or breastfeeding.

Do not use this medication if you have bladder or bowel obstruction.

Before taking Mestinon, tell your doctor if you have asthma or kidney disease. Since this medication can cause blurred vision, do not drive or operate any heavy machinery after taking. Do not drink alcohol after taking Mestinon as it can increase certain side effects of Pyridostigmine.

This medication is not approved to be taken by anyone under the age of 18.

How Does Mestinon Work?

This medication is an acetylcholinesterase inhibitor that functions by inhibiting the action of the anticholinesterase enzymes within the body. These enzymes are what break down the acetylcholine in a person’s system, contributing to reduced neurotransmitter activity that can result in certain individuals developing conditions such as myasthenia gravis, Alzheimer’s disease, and Parkinson’s disease.

By preventing the excessive breakdown of acetylcholine, the symptoms of the conditions associated with low levels of neurotransmitter activity involving acetylcholine are alleviated.

Dosage

This medication is available in tablet form in the following strengths:

  • 30 mg
  • 60 mg
  • 180 mg (extended-release)

The most common dose for those using the immediate-release tablets is 600 mg per day. This typically consists of the patient taking 10 of the 60 mg tablets, often split into multiple smaller doses to be taken throughout the course of the day. However, the dosage prescribed by a patient’s doctor may vary. This is why it is essential that patients using this medication follow their doctor’s instructions exactly to ensure that they are receiving the proper dosage sizes at the correct times of day for maximum safety and efficacy.

Patients using the extended-release tablets will typically consume a daily dose of 1 to 3 tablets either once or twice per day. Again, though, this may vary based on what the individual’s doctor has determined will be the safest and most effective dosing schedule to manage their symptoms, and patients using the extended-release tablets should take their medication exactly as instructed by their prescribing physician.

Overdose

If an overdose has occurred or is suspected, you should contact your physician or local Poison Control Center for further guidance.

Some of the symptoms one might experience when overdosing on this medication include the following:

  • blurry vision
  • breathing difficulties
  • diarrhea
  • drooling
  • nausea
  • stomach cramps
  • sweating
  • vomiting

If you or someone else have overdosed on this medication and lose consciousness or stop breathing, emergency medical attention should be sought immediately.

Additionally, some individuals may experience either no changes in their condition or a worsening of their myasthenia gravis symptoms as a result of overdosing on Mestinon.

Side Effects

The use of this medication is associated with a number of different side effects that may vary in severity. Please contact your prescribing physician if you have any questions or concerns or if your condition worsens or does not appear to be affected by your current dosage of the medication.

The most common side effects of taking Mestinon are as follows:

  • anxiety
  • blurry vision
  • cold sweats
  • diarrhea
  • feeling panicky
  • increased salivation (drooling)
  • increased urge to urinate
  • muscle weakness
  • paleness of the skin
  • sweating
  • upset stomach
  • vomiting
  • watery eyes

Some of the following side effects may occur and should be reported to your doctor immediately if they occur while taking this medication:

  • breathing difficulties
  • confusion
  • extreme itchiness or hives
  • seizures
  • severe skin rash
  • slurring of one’s speech

Warnings & Precautions

This medication comes with a number of potential health risks for patients with certain preexisting conditions. Please be sure to discuss your medical history and any current medications with your doctor before beginning treatment with Mestinon.

Bradycardia

Patients with a medical history including bradycardia (slow heart rate) or other cardiac conditions are at an increased risk of experiencing both heart block as well as a significant reduction in their heart rate due to Mestinon’s effect on the vagus nerve. Patients that are likely to be impacted by this risk should be sure to discuss any previous instances of bradycardia or other cardiac abnormalities with their physician before beginning treatment with this medication. Episodes of fainting have been reported in patients using this medication due to a slowed heart rate.

Bronchospasms

Individuals with asthma or chronic obstructive pulmonary disorder (COPD) are advised to exercise caution when taking this medication and may require special monitoring. As an acetylcholinesterase inhibitor, this medication may cause side effects such as increasing the bronchial secretions in a patient, causing additional constriction of the patient’s bronchi, and triggering bronchospasms. All three of these factors are capable of negatively impacting the conditions of those with asthma or COPD. Changes in the prescribed dosage of Mestinon may be made as needed for patients with preexisting respiratory conditions that still need to use this acetylcholinesterase inhibitor for treatment.

Coronary Artery Disease

Mestinon is associated with increased instances of coronary artery constriction occurring in those using the medication. Individuals with a history of atherosclerotic or ischemic heart disease should exercise caution when taking this medication and be sure to inform their doctor of any medical conditions that may be impacted by the constriction of the patient’s coronary arteries that may occur while using this medication for treatment.

Hyperthyroidism

Changes in a patient’s acetylcholine levels have been linked to a worsening of the symptoms associated with hyperthyroidism in individuals who have this condition and are taking this medication for treatment. Patients with a history of hyperthyroidism will often require regular monitoring of their thyroid levels throughout the duration of their use of Mestinon.

Parkinson’s Disease

The changes that occur in a patient’s acetylcholine levels while using Mestinon may cause a worsening of symptoms in those who are taking this medication and who also have Parkinson’s disease. Patients with this condition should exercise caution when using this medication or any other medications that affect cholinergic activity within the body, as these may cause a significant increase in Parkinson’s-related symptoms.

Peptic Ulcers

Mestinon is associated with a number of adverse side effects that impact the patient’s gut. Individuals with peptic ulcer disease are at an increased risk of gastric contractions and increased stomach acid production while using this medication. Patients with a history of gastrointestinal conditions, peptic ulcers, acid reflux, and other similar conditions should inform their prescribing physician of these aspects of their medical history before beginning treatment with this medication.

Seizures

This medication has been linked to instances of tremors, convulsions, and seizures occurring in some patients using it for treatment. Patients with a medical history that includes certain seizure disorders and other conditions that may increase the likelihood of them experiencing seizures and convulsions are advised to use extreme caution when taking Mestinon.

Additional Medical Conditions

If you have any of the following medical conditions, exercise caution when taking Mestinon and discuss your medical history with your doctor before beginning this medication:

  • asthma
  • bradycardia
  • bronchospasm
  • coronary artery disease
  • hyperthyroidism
  • kidney disease
  • parkinsonism
  • PUD
  • seizures

Drug Interactions

Speak to your doctor about any medications or herbal supplements you are currently taking before beginning treatment with this medication. Discuss any concerns you may have with your doctor or a trusted pharmacist.

These medications and supplements are known to interact with Mestinon and may increase your chances of experiencing adverse side effects:

  • alectinib
  • amifampridine
  • amikacin
  • amikacin liposome
  • ascorbic acid
  • aspirin
  • atropine
  • belladonna
  • benztropine
  • betamethasone
  • bethanechol
  • biperiden
  • brigatinib
  • budesonide
  • cellulose
  • cetirizine (Zyrtec)
  • cholecalciferol
  • clidinium
  • clozapine
  • corticorelin
  • corticotropin
  • cortisone
  • cosyntropin
  • crizotinib
  • cyanocobalamin
  • darifenacin
  • deflazacort
  • dexamethasone
  • dicyclomine
  • disopyramide
  • donepezil
  • duloxetine (Cymbalta)
  • echothiophate iodide ophthalmic
  • edrophonium
  • fingolimod
  • flavoxate
  • fludrocortisone
  • gabapentin
  • galantamine
  • gentamicin
  • glycopyrrolate
  • hydrocortisone
  • hyoscyamine
  • ivabradine
  • kanamycin
  • lasmiditan
  • levothyroxine (Synthroid)
  • lisinopril
  • melatonin
  • mepenzolate
  • methscopolamine
  • methylcellulose
  • methylprednisolone
  • midodrine
  • montelukast (Singulair)
  • mycophenolate mofetil (CellCept)
  • neomycin
  • neostigmine
  • netilmicin
  • omeprazole
  • ondansetron (Zofran)
  • oxybutynin
  • ozanimod
  • paromomycin
  • physostigmine
  • plazomicin
  • ponesimod
  • prednisolone
  • prednisone
  • procainamide
  • procyclidine
  • propantheline
  • quinidine
  • rivastigmine
  • scopolamine
  • siponimod
  • solifenacin
  • streptomycin
  • succinylcholine
  • tacrine
  • thalidomide
  • tobramycin
  • tolterodine
  • tramadol
  • trazodone
  • triamcinolone
  • triamcinolone ophthalmic
  • trihexyphenidyl
  • trospium
  • vitamin B12
  • vitamin C
  • vitamin D3

Alternative Medications

For patients who are unable to take Mestinon or experiencing significant adverse side effects, alternative medications may be used to treat some of the associated conditions for which this medication is commonly prescribed:

  • azathioprine (Azasan, Imuran)
  • cyclophosphamide (Cytoxan, Neosar)
  • cyclosporine (Neoral, Sandimmune)
  • eculizumab (Soliris)
  • methotrexate
  • mycophenolate mofetil (CellCept)
  • neostigmine (Prostigmin)
  • prednisone
  • ravulizumab (Ultomiris)
  • tacrolimus (Prograf)

Frequently Asked Questions

Mestinon is primarily used in the treatment of the symptoms associated with myasthenia gravis. It is also utilized as a pretreatment for individuals that have been exposed to certain nerve agents, as well as to reverse the effects of muscle relaxants that are non-depolarizing.

This medication should not be used by any individuals that are allergic to pyridostigmine or any of the other ingredients included in Mestinon tablets. It should also not be used by those who are pregnant, breastfeeding, have kidney disease, have asthma, or have any obstructions of the bowels or bladder.

The most common side effects experienced by those using this medication include diarrhea, nausea, vomiting, stomach cramps, increased salivation, blurry vision, sweating, a rash, or developing a cough with mucus.

Some of the serious side effects that may occur when using this medication include the loss of movement in certain body parts, significant vision problems, difficulty breathing, slurring of speech, extreme muscle weakness, worsening of myasthenia gravis symptoms, or no improvement occurring in the condition whatsoever.

It has not been determined if this medication causes adverse effects to occur in an unborn child. Patients using this medication should discuss the matter with their prescribing physician if they are using Mestinon and become pregnant during treatment or are planning to become pregnant while using this medication. Additionally, it has also not been determined if this medication is passed into breast milk or how this may affect a breastfed child. Patients using this medication should discuss the potential risks with their doctor if they desire to breastfeed a child during treatment with Mestinon.

As this medication is capable of causing visual or coordination-related impairments, patients are advised to use caution when engaging in any activities that require focus and clear vision until they are sure of how Mestinon affects them. Patients are also advised to avoid or limit alcohol consumption while using this medication due to alcohol’s ability to further increase the likelihood and severity of some of the common side effects.

This medication should be taken exactly as instructed by the patient’s prescribing physician. Typically, most patients will take multiple doses of Mestinon throughout the day, with the most common dosing size being 600 mg of the medication per day (i.e., 10 of the 60 mg tablets per day). However, the dosage prescribed to each patient using this medication may vary.

If a patient has missed a dose of this medication and the next scheduled dose is not coming up soon, they should go ahead and take the missed dose. However, if it is nearly time for the individual’s next scheduled dose, they should simply skip and disregard the missed dose and proceed with their usual dosing schedule. Patients using Mestinon should not double up on the medication to compensate for any missed doses.

If an overdose has occurred or is suspected, you should contact your physician or local Poison Control Center for further guidance. Some of the symptoms one might experience when overdosing on this medication include digestive disturbances, blurry vision, sweating, drooling, and breathing difficulties. If you or someone else have overdosed on this medication and lose consciousness or stop breathing, emergency medical attention should be sought immediately.

Individuals with asthma, impaired kidney function, or any blockages of the intestines, stomach, or urinary tract should not take Mestinon.

This medication is known to interact with many of the available corticosteroids, certain anticholinesterase medications, cholinergic medications, and beta-blockers. Please discuss any current medications you are taking with your physician or a trusted pharmacist before taking Mestinon.

If someone has overdosed on this medication, they will likely experience the following symptoms and require medical attention: blurry vision, breathing difficulties, diarrhea, drooling, nausea, stomach cramping, sweating, and vomiting. If fainting occurs or the individual who consumed too much Mestinon stops breathing, emergency medical attention should be sought immediately.

Mestinon is available in tablet form, and there is an immediate-release tablet as well as an extended-release version of the medication.

The active ingredient in all strengths of this medication is pyridostigmine bromide. The inactive ingredients in the 10 mg strength of this medication are as follows: pregelatinized potato starch, magnesium stearate, purified talc, lactose monohydrate, colloidal anhydrous silica, and maize starch. The inactive ingredients in the 60 mg tablets include the following: rice starch, sucrose, hard paraffin, liquid paraffin, pregelatinized potato starch, magnesium stearate, iron oxide yellow CI77492, iron oxide red CI77491, acacia, povidone, purified talc, colloidal anhydrous silica, and maize starch. The 180 mg tablets contain the following inactive ingredients: magnesium stearate, zein, calcium phosphate, colloidal anhydrous silica, and carnauba wax.

This medication is an acetylcholinesterase inhibitor and not a steroid or a corticosteroid. However, some patients that are not seeing the ideal level of control of their myasthenia gravis symptoms may be prescribed steroids to use alongside this medication to further improve their condition and reduce the body’s excessive immune response that is contributing to the condition in the first place.

Patients using this medication should not immediately stop using it without first consulting with their prescribing physician to ensure that this can be done safely without causing any significant health risks. When an individual stops using Mestinon, their myasthenia gravis symptoms will return as well as significant muscle weakness. If a patient’s myasthenia gravis symptoms are severe when not regulated with the use of Mestinon, the return of these symptoms may potentially be life-threatening in some cases. This medication should be taken as directed and only stopped under the guidance of the patient’s prescribing physician.

Although this medication does not treat myasthenia gravis itself nor directly impact the condition, it instead helps in reducing the associated muscle weakness that occurs in those who have this condition. This medication assists in increasing the activity between the body’s chemical transmitters, allowing the muscles and nerves to communicate more effectively and function better.