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Indication & Dosage |
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| Oral |
| MYASTHENIA GRAVIS |
| Adult:
0.3-1.2 g daily in divided doses. |
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| Oral |
| MYASTHENIA GRAVIS |
| Child:
<6 yr: Initially, 30 mg, 6-12 yr: Initially, 60 mg. Dose may be gradually increased by 15-30 mg on a daily basis until a satisfactory response is observed. |
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| Oral |
| NEONATAL MYASTHENIA GRAVIS |
| Child:
5-10 mg given every 4-6 hr. |
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| Oral |
| PARALYTIC ILEUS AND POSTOPERATIVE URINARY RETENTION |
| Adult:
60-240 mg. |
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| Intravenous |
| REVERSAL OF NEUROMUSCULAR BLOCKADE |
| Adult:
10-20 mg with or preceded by 0.6-1.2 mg atropine sulfate to counteract any muscarinic effects. |
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| Intramuscular |
| NEONATAL MYASTHENIA GRAVIS |
| Adult:
50-150 mcg/kg, given every 4-6 hr. |
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| Administration |
Should be taken with food. |
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| Precautions |
Renal impairment, pregnancy and lactation, epilepsy, bronchial asthma, bradycardia, cardiac arrhythmias, recent coronary occlusion, vagotonia, hyperthyroidism, peptic ulcer, recent bladder/intestinal surgery. Care should be taken in the use of atropine for counteracting side effects. |
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| Adverse Drug Reactions |
Muscarinic side effects e.g. nausea, vomiting, diarrhoea, abdominal cramps, increased peristalsis, increased salivation, increased bronchial secretions, miosis and diaphoresis. Nicotinic side effects include muscle cramps, fasciculation and weakness. |
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| Interactions |
Quaternary ammonium ions are poorly absorbed and their absorption may be completely inhibited by bulk laxatives eg, methylcellulose. Quinidine, procainamide, propranolol block acetylcholine receptor and may aggravate myasthenia gravis. Antagonistic effects with atropine. Increased risk of bradycardia and hypotension when used with β-blockers. Drugs with neuromuscular blocking activity e.g. aminoglycosides may reduce the efficacy of pyridostigmine. |
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