Side Effects of pyridostigmine: A Synthesis of Findings from 29 Studies

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Original Abstract of the Article

Major findings

Pyridostigmine is a medication used to treat myasthenia gravis, a condition that causes muscle weakness. This medication works by inhibiting acetylcholinesterase, an enzyme that breaks down acetylcholine, a neurotransmitter. This increases the amount of acetylcholine in the body, which helps to improve muscle function.

However, pyridostigmine can cause a variety of side effects, including nausea, vomiting, abdominal pain, diarrhea, bradycardia, heart block, headache, dizziness, sweating, muscle contractions, seizures, bronchospasm, and difficulty breathing. These side effects are generally mild and temporary, but they can be serious in some cases. 1

Reasons for side effects

The side effects of pyridostigmine are due to its effect on the nervous system. By inhibiting acetylcholinesterase, pyridostigmine increases the amount of acetylcholine in the body, which can lead to overstimulation of the nervous system. This overstimulation can cause a variety of symptoms, such as those listed above.

Common side effects

Digestive System

Pyridostigmine can cause side effects in the digestive system. These side effects include nausea, vomiting, abdominal pain, and diarrhea. 17

Heart

Pyridostigmine can cause side effects in the heart. These side effects include bradycardia, atrial fibrillation, atrial flutter, and heart block. 10

Nervous system

Pyridostigmine can cause side effects in the nervous system. These side effects include headache, dizziness, sweating, muscle contractions, seizures, and altered consciousness. 1

Respiratory system

Pyridostigmine can cause side effects in the respiratory system. These side effects include bronchospasm and difficulty breathing. 1

Other

In addition to these, pyridostigmine can cause side effects such as excessive salivation, excessive sweating, visual disturbances, and urinary incontinence. 1

Countermeasures for side effects

Digestive System

For digestive system side effects from pyridostigmine, diet and drug therapy can be effective. In diet therapy, it is important to eat easy-to-digest foods and avoid fatty and spicy foods. Drug therapy includes the use of antiemetics, antacids, and intestinal regulators. 17

Heart

For heart side effects from pyridostigmine, monitoring of ECG and, if necessary, treatment such as a cardiac pacemaker may be required. 10

Nervous system

For nervous system side effects from pyridostigmine, drug therapy can be effective. Drug therapy includes the use of analgesics, sedatives, and anticonvulsants. 1

Respiratory system

For respiratory side effects from pyridostigmine, treatment such as bronchodilators may be required. 1

Other

Other side effects from pyridostigmine are treated with various treatment methods depending on the symptoms. For example, desiccants are used for excessive salivation. Anticholinergics are used for excessive sweating. Eyeglasses are used for visual disturbances. Urinary incontinence is treated with bladder training and, if necessary, drug therapy. 1

Comparison of studies

Commonalities of studies

These studies share the commonality that the side effects of pyridostigmine are due to the inhibition of acetylcholinesterase. Another commonality is that the frequency of side effects varies depending on the patient and the dosage.

Differences of studies

These studies differ in their study subjects, research methods, and analysis methods. Therefore, it is difficult to compare the research results, but these studies clearly show that pyridostigmine can cause a variety of side effects.

Precautions for application in real life

Pyridostigmine should be taken according to your doctor's instructions. When taking it, be aware of side effects, and if you feel unwell, consult your doctor immediately. Also, pyridostigmine is not safe for use during pregnancy or breastfeeding.

Limitations of current research

Research on the side effects of pyridostigmine is not yet sufficient. More research is needed in the future.

Future research directions

Research on ways to reduce the side effects of pyridostigmine is needed in the future. For example, research could be done on whether side effects can be reduced by combining pyridostigmine with other medications.

Conclusion

Pyridostigmine is an effective drug for the treatment of myasthenia gravis, but it can cause various side effects. When taking pyridostigmine, be aware of side effects, and if you feel unwell, consult your doctor immediately.

Literature analysis of 29 papers
Positive Content
25
Neutral Content
2
Negative Content
2
Article Type
3
0
1
2
25
1.

Side effects of low-dose pyridostigmine bromide are not related to cholinesterase inhibition.

Author: CookM R, GerkovichM M, SastreA, GrahamC

Chemical warfare protection
Side effects

Pyridostigmine bromide (PB) is used to protect against chemical warfare attacks. This study aimed to determine the side effects of low-dose PB, including their type, intensity, and frequency. It also aimed to identify factors predicting the side effects' intensity and frequency.

Clinical TrialA clinical trial is a planned study conducted on humans to evaluate the efficacy and safety of pharmaceuticals, medical devices, and treatment methods. It aims to explore the possibilities of new treatments and improve the health of patients.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.
Research Support, U.S. Gov't, Non-P.H.S.Research funding provided by US government agencies other than the Public Health Service.

Language : English

2.

Prevention of peripheral side-effects of transdermal hyoscine by adjunctive therapy with low dosage of pyridostigmine.

Author: ZivI, VersanoD, RuachM, IzraeliS, AlmogS, AlhalelA, AlkalayM, MenahemS, TochnerZ

Increases tolerability of hyoscine
Prevents salivary flow impairment

Low-dose pyridostigmine effectively prevented the peripheral anti-muscarinic side effects of transdermal hyoscine in 47 healthy subjects. Pyridostigmine may increase the tolerability of transdermal hyoscine therapy.

Clinical TrialA clinical trial is a planned study conducted on humans to evaluate the efficacy and safety of pharmaceuticals, medical devices, and treatment methods. It aims to explore the possibilities of new treatments and improve the health of patients.
Controlled Clinical TrialA clinical trial that evaluates the effectiveness of a treatment by comparing a group that receives the intervention with a group that receives a placebo or standard treatment.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.

Language : English

3.

Bretazenil, a benzodiazepine receptor partial agonist, as an adjunct in the prophylactic treatment of OP poisoning.

Author: TashmaZ, RavehL, LianiH, AlkalayD, GivoniS, KaponJ, CohenG, AlcalayM, GrauerE

Effective anticonvulsants
Fewer side effects
Incapacitation

Bretazenil, a partial benzodiazepine agonist, is a promising candidate for preventing organophosphate poisoning.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.

Language : English

5.

Vincristine induced cranial polyneuropathy.

Author: BayAli, YilmazCahide, YilmazNebi, OnerAhmet Faik

Cranial polyneuropathy recovery

A 5-year-old girl with vincristine-induced cranial polyneuropathy showed recovery with pyridoxine and pyridostigmine treatment.

Case ReportsIn the medical field, a report that describes in detail a unique case, an unusual medical condition, or the effect of a treatment. Provides new insights and possibilities for treatment through individual patient cases.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.

Language : English

6.

Repeated stress in combination with pyridostigmine Part I: long-term behavioural consequences.

Author: LamproglouIoannis, BarbierLaure, DiserboMichel, FauvelleFlorence, FauquetteWilliam, AmouretteChristine

Cognitive dysfunction
Learning dysfunction

This study developed an experimental model of Gulf War Illness (GWI) using repeated stress in rats and evaluated the long-term effects of pyridostigmine treatment.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

7.

Diagnosis of growth hormone (GH) deficiency in adults with hypothalamic-pituitary disorders: comparison of test results using pyridostigmine plus GH-releasing hormone (GHRH), clonidine plus GHRH, and insulin-induced hypoglycemia as GH secretagogues.

Author: HoeckH C, VestergaardP, JakobsenP E, FalhofJ, LaurbergP

Evaluate GH deficiency

The insulin tolerance test (ITT) is a widely accepted method to evaluate GH secretion capacity in adults with hypothalamic-pituitary disorders. However, the ITT is not suitable in the elderly or in patients with cardiovascular disease or seizure disorders. Alternatives to the ITT have been introduced. This study investigated the diagnostic outcome with the ITT, the pyridostigmine plus GHRH (PD+GHRH) test, the clonidine plus GHRH (CLO+GHRH) test, and insulin-like growth factor I (IGF-I) in an unselected group of patients with hypothalamic-pituitary disease. Two stimulation tests should be performed to establish a diagnosis of GH deficiency in patients with hypothalamic-pituitary disease and a normal IGF-I level. In patients with a subnormal IGF-I value, a single GH stimulation test should be sufficient to confirm the presence of GH deficiency.

Comparative StudyResearch that compares multiple groups/interventions to determine differences/similarities in outcomes/characteristics.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

8.

Myasthenia Gravis Presenting after Administration of the mRNA-1273 Vaccine.

Author: HoshinaYoji, SowersChristopher, BakerVirginia

MG development

This case report presents a case of myasthenia gravis (MG) that became clinically apparent following vaccination against SARS-CoV-2.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.

Language : English

9.

Coding for Medication-related Poisoning and Adverse Effects.

Author: YuMelissa

This article provides an overview of coding considerations for patient encounters related to medication use, abuse, or poisoning. Accurate coding is crucial for proper reimbursement and documentation of care provided in these situations.

Case ReportsIn the medical field, a report that describes in detail a unique case, an unusual medical condition, or the effect of a treatment. Provides new insights and possibilities for treatment through individual patient cases.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.

Language : English

10.

Treatment of pyridostigmine-induced AV block with hyoscyamine in a patient with myasthenia gravis.

Author: GehiAnil, BenatarMichael, LangbergJonathan

Myasthenia gravis treatment
Bradycardia
Syncope

A 60-year-old man with myasthenia gravis, a disorder that causes muscle weakness, experienced syncope due to high-degree AV block, a condition that disrupts the electrical signals from the heart to the ventricles. Treatment with hyoscyamine, a muscarinic antagonist, resolved the AV block and prevented the need for a pacemaker.

Case ReportsIn the medical field, a report that describes in detail a unique case, an unusual medical condition, or the effect of a treatment. Provides new insights and possibilities for treatment through individual patient cases.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.

Language : English

11.

The reduced release of GH by GHRH in 8 subjects aged 65-69 years is augmented considerably by rivastigmine, a drug for Alzheimer's disease.

Author: ObermayrRudolf P, MayerhoferLothar, KnechtelsdorferMaarten, TraglKarl H, GeyerGeorg

GH secretion
Peripheral cholinergic side-effects

Cholinesterase inhibitors like pyridostigmine can elicit growth hormone secretion, but their clinical use is limited due to strong peripheral cholinergic side effects.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

13.

[Efficacy and safety of low-dose cyclophosphamide plus corticosteroids for type I/II myasthenia gravis].

Author: FengHui-yu, LiuWei-bin, HuangXin, QiuLi, LiYan, WangHai-yan, LuoChuan-ming

MG treatment
Side effects

The combined treatment of low-dose cyclophosphamide and corticosteroids for type I/II myasthenia gravis is both effective and safe. The treatment is more effective in type I patients, requiring 4-8g of cyclophosphamide versus 8-12g for type II patients.

Clinical TrialA clinical trial is a planned study conducted on humans to evaluate the efficacy and safety of pharmaceuticals, medical devices, and treatment methods. It aims to explore the possibilities of new treatments and improve the health of patients.
English AbstractA summary of a research paper/publication written in English for a wider audience.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Research Support, U.S. Gov't, Non-P.H.S.Research funding provided by US government agencies other than the Public Health Service.

Language : Chinese

15.

Management of myasthenic conditions: nonimmune issues.

Author: ArgovZohar

Improved respiration
Myasthenia gravis
Statin aggravation

Antisense compounds inhibiting acetylcholine esterase have positive therapeutic effects during short-term administration. Bilevel positive airway pressure and other external respiratory supportive systems may prevent or shorten the need for intubation in myasthenic crises.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.

Language : English

16.

Rare Case of Iatrogenic Myocardial Infarction Induced by Use of Pyridostigmine.

Author: NiaziMuhammad, IqbalQasim Z, ZiaZeeshan, SattarSaud Bin Abdul, LaffertyJames

Treats myasthenia gravis
Myocardial infarction

This case report highlights the potential risk of myocardial infarction in elderly females with myasthenia gravis treated with acetylcholinesterase medications like pyridostigmine. The patient, an 88-year-old female with paraneoplastic myasthenia gravis, developed chest pain and ST-elevation on EKG after starting pyridostigmine, which was likely due to coronary vasospasm or arrhythmogenic effects.

Case ReportsIn the medical field, a report that describes in detail a unique case, an unusual medical condition, or the effect of a treatment. Provides new insights and possibilities for treatment through individual patient cases.

Language : English

17.

Pyridostigmine enhances glutamatergic transmission in hippocampal CA1 neurons.

Author: PavlovskyLev, BrowneR Orie, FriedmanAlon

Myasthenia gravis
Excitotoxic damage

Pyridostigmine, a carbamate acetylcholinesterase (AChE) inhibitor, is used to treat myasthenia gravis. Although it doesn’t normally cross the blood-brain barrier, studies suggest that it can enter the brain under certain conditions, affecting cortical excitability and gene expression. This study aims to understand the mechanisms of pyridostigmine-induced changes in central neuron excitability.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.
Research Support, U.S. Gov't, Non-P.H.S.Research funding provided by US government agencies other than the Public Health Service.

Language : English

18.

Preparation and in vitro screening of symmetrical bispyridinium cholinesterase inhibitors bearing different connecting linkage-initial study for Myasthenia gravis implications.

Author: MusilekKamil, KomloovaMarketa, ZavadovaVlasta, HolasOndrej, HrabinovaMartina, PohankaMiroslav, DohnalVlastimil, NachonFlorian, DolezalMartin, KucaKamil, JungYoung-Sik

MG treatment
Side effects

This study investigated the inhibitory effects of 20 newly prepared bispyridinium compounds on acetylcholinesterase (AChE) and butyrylcholinesterase (BChE) in vitro. Three compounds demonstrated promising inhibition of both enzymes, comparable to standard carbamate drugs. These novel inhibitors could potentially be used for the treatment of Myasthenia gravis.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

19.

Coincidental Onset of Ocular Myasthenia Gravis Following ChAdOx1 n-CoV-19 Vaccine against Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2).

Author: GalassiGiuliana, RispoliVittorio, IoriErika, AriattiAlessandra, MarchioniAlessandro

COVID-19 vaccine
Thrombotic events

This article discusses a potential link between the Oxford-AstraZeneca vaccine ChAdOx1 and myasthenia gravis (MG), a rare autoimmune disorder affecting muscle function. While rare, this possible side effect is being investigated.

Case ReportsIn the medical field, a report that describes in detail a unique case, an unusual medical condition, or the effect of a treatment. Provides new insights and possibilities for treatment through individual patient cases.
LetterA written message for communication and exchange of information between individuals.

Language : English

20.

Pretreatment and prophylaxis against nerve agent poisoning: Are undesirable behavioral side effects unavoidable?

Author: MyhrerTrond, AasPål

Nerve agent protection
Behavioral impairment

Pyridostigmine is a medication used for pretreatment against chemical warfare agents. This study discusses the potential side effects of pyridostigmine on behavior in animals.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.

Language : English

21.

Cholinergic stimulation with pyridostigmine reduces the QTc interval in coronary artery disease.

Author: CastroR R T, PorphirioG, SerraS M, NóbregaA C L

Potential cardioprotection
Reduced QTc interval

This study investigated the effects of pyridostigmine bromide (PYR), an anticholinesterase agent, on electrocardiographic variables in patients with stable coronary artery disease. PYR significantly decreased the QTc interval, indicating potential cardioprotection through cholinergic stimulation.

Clinical TrialA clinical trial is a planned study conducted on humans to evaluate the efficacy and safety of pharmaceuticals, medical devices, and treatment methods. It aims to explore the possibilities of new treatments and improve the health of patients.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

23.

A retrospective clinical study of the treatment of slow-channel congenital myasthenic syndrome.

Author: ChaouchAmina, MüllerJuliane S, GuergueltchevaVelina, DuslMarina, ScharaUlrike, Rakocević-StojanovićVidosava, LindbergChristopher, ScolaRosana H, WerneckLineu C, ColomerJaume, NascimentoAndres, VilchezJuan J, MuelasNuria, ArgovZohar, AbichtAngela, LochmüllerHanns

Slow-channel CMS treatment
Adverse effects

Slow-channel congenital myasthenic syndrome (CMS) is a rare condition caused by mutations in the acetylcholine receptor. Treatment with fluoxetine, an open channel blocker, was beneficial for most patients, but side effects hindered treatment effectiveness in some.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

24.

The use of intravenous immunoglobulin as maintenance therapy in myasthenia gravis.

Author: HilkevichO, DroryV E, ChapmanJ, KorczynA D

MG treatment

Intravenous immunoglobulin maintenance therapy can effectively manage myasthenia gravis, reducing the need for mechanical ventilation, steroid dosage, and improving overall patient outcomes.

Clinical TrialA clinical trial is a planned study conducted on humans to evaluate the efficacy and safety of pharmaceuticals, medical devices, and treatment methods. It aims to explore the possibilities of new treatments and improve the health of patients.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

25.

Side effects of low-dose pyridostigmine bromide are not related to cholinesterase inhibition.

Author: CookM R, GerkovichM M, SastreA, GrahamC

Chemical warfare protection
Side effects

Pyridostigmine bromide (PB) is used to protect against chemical warfare attacks. This study aimed to determine the side effects of low-dose PB, including their type, intensity, and frequency. It also aimed to identify factors predicting the side effects' intensity and frequency.

Clinical TrialA clinical trial is a planned study conducted on humans to evaluate the efficacy and safety of pharmaceuticals, medical devices, and treatment methods. It aims to explore the possibilities of new treatments and improve the health of patients.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.
Research Support, U.S. Gov't, Non-P.H.S.Research funding provided by US government agencies other than the Public Health Service.

Language : English

27.

Use of acetylcholinesterase inhibitors in reducing time to gastrointestinal function recovery following abdominal surgery: A systematic review.

Author: TraegerLuke, Dudi-VenkataNagendra, BedrikovetskiSergei, KroonHidde M, MooreJames W, SammourTarik

Reduced POI

This review investigates the use of acetylcholinesterase inhibitors, neostigmine and pyridostigmine, to reduce the time to return of gastrointestinal function after abdominal surgery.

Systematic ReviewA review that systematically collects, evaluates, and integrates relevant research to answer a specific research question.

Language : English

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