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Mestinon
Mestinon is the brand name for pyridostigmine bromide, a medication primarily prescribed to treat myasthenia gravis, a chronic autoimmune disorder that affects muscle strength. Mestinon belongs to the class of drugs known as cholinesterase inhibitors, which help improve muscle strength by preventing the breakdown of acetylcholine, a chemical messenger needed for communication between nerves and muscles. This medication helps patients manage symptoms like muscle weakness and fatigue associated with myasthenia gravis. Mestinon is also sometimes used off-label to treat certain cases of orthostatic hypotension.
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Frequently Asked Questions
How quickly does Mestinon start to work?
Mestinon typically starts to work within 30 to 60 minutes after taking an oral dose, with effects lasting about 4 to 6 hours for the immediate-release form.
Can Mestinon be used long-term?
Yes, Mestinon can be used long-term to manage the symptoms of myasthenia gravis. However, regular monitoring by a healthcare provider is necessary to adjust the dose as needed.
What should I do if I miss a dose?
If you miss a dose of Mestinon, take it as soon as you remember. If it is almost time for your next dose, skip the missed dose and continue with your regular schedule. Do not double the dose to catch up.
Can Mestinon cause weight gain?
Weight gain is not a common side effect of Mestinon. However, any concerns about weight changes should be discussed with your healthcare provider.
Is it safe to take Mestinon during pregnancy?
Mestinon is considered relatively safe during pregnancy, but it should only be used if clearly needed and prescribed by a healthcare provider. Always discuss the risks and benefits with your doctor.
Comprehensive Drug Guide
How Does Mestinon Work?
Mestinon works by inhibiting acetylcholinesterase, the enzyme responsible for breaking down acetylcholine, a neurotransmitter that transmits signals between nerves and muscles. By preventing the breakdown of acetylcholine, Mestinon increases the availability of this neurotransmitter, enhancing nerve-to-muscle communication. This helps improve muscle contraction and reduces the muscle weakness and fatigue seen in patients with myasthenia gravis.
Common Dosages
- Tablets: 60 mg
- Extended-release tablets: 180 mg
- Syrup: 60 mg per 5 mL
Typical Dosing
- For myasthenia gravis: The typical starting dose is 60 mg taken orally three times daily. The dosage may be adjusted based on the patient’s response and severity of symptoms.
- For extended-release tablets: One 180 mg tablet every 12 hours is commonly prescribed.
- For syrup: The dose is usually adjusted based on body weight and individual needs, especially in children or those with difficulty swallowing pills.
Typical Dosing
FDA Approved Indications
- Myasthenia gravis
- Reversal of non-depolarizing muscle relaxants used during surgery
Off-label uses may include:
- Orthostatic hypotension
- Postural tachycardia syndrome (POTS)
Who Shouldn't Take Mestinon?
- Known hypersensitivity to pyridostigmine or any component of the formulation
- Mechanical intestinal or urinary obstruction
Advice From The Pharmacist
- Mestinon should be taken at regular intervals to maintain steady levels of the medication in your bloodstream.
- Take Mestinon with food or milk to reduce the likelihood of gastrointestinal side effects.
- If you are prescribed the extended-release tablets, do not crush or chew them; they must be swallowed whole.
- Ensure you stay hydrated, as Mestinon can increase saliva production and cause excessive sweating.
- Contact your healthcare provider if you experience muscle twitching, abdominal cramps, or excessive weakness, as these could be signs of overmedication.
Side Effects of Mestinon
Common Side Effects
- Nausea
- Diarrhea
- Increased salivation
- Abdominal cramps
- Sweating
Uncommon/Severe Side Effects
- Severe muscle weakness (potential sign of cholinergic crisis)
- Breathing difficulties
- Allergic reactions (rash, itching, swelling, difficulty breathing)
Risks and Warnings of Mestinon
- Cholinergic Crisis: Overdose of Mestinon can lead to a cholinergic crisis, characterized by extreme muscle weakness, difficulty breathing, and other serious symptoms. This condition requires immediate medical attention.
- Asthma and Respiratory Conditions: Patients with asthma or other respiratory conditions should be cautious, as Mestinon may exacerbate bronchial secretions or respiratory difficulties.
- Cardiovascular Issues: Use with caution in individuals with heart conditions, as the medication may cause bradycardia (slow heart rate).
Interactions with Mestinon
Common Drug Interactions
- Other Cholinesterase Inhibitors: Combining Mestinon with other cholinesterase inhibitors may increase the risk of cholinergic crisis.
- Beta-blockers: The combination may increase the risk of bradycardia or hypotension.
- Anticholinergic medications: These may counteract the effects of Mestinon.
Alternatives to Mestinon
- Neostigmine: Another cholinesterase inhibitor used for myasthenia gravis and reversal of muscle relaxants.
- Azathioprine: An immunosuppressive drug used in conjunction with cholinesterase inhibitors for more severe cases of myasthenia gravis.
- Corticosteroids: May be used to manage inflammation and immune response in myasthenia gravis.
- Rituximab: A biologic therapy sometimes used in refractory cases of myasthenia gravis.
