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Pyridostigmine Coupon - Pyridostigmine 60mg tablet

pyridostigmine

Generic Mestinon
Used for Myasthenia Gravis

Pyridostigmine (Mestinon) is a cholinesterase inhibitor that's commonly used for treating muscle weakness due to myasthenia gravis in adults. It works by improving the communication between the muscles and nerves. This medication is available as a tablet and liquid that are taken by mouth multiple times per day. Side effects aren't common, but taking too much can cause stomach upset, too much saliva, and muscle problems.

Reviewed by:
reviewerAileen Chu, PharmD, BCPS
reviewerRobert Chad Hakim, PharmD, BCCCP
Last reviewed on November 12, 2023
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What is Pyridostigmine (Mestinon)?

What is Pyridostigmine (Mestinon) used for?

How Pyridostigmine (Mestinon) works

Pyridostigmine (Mestinon) is a cholinesterase inhibitor. It blocks a protein called cholinesterase from breaking down acetylcholine, a chemical in your body that's important for communication between your nerve cells and muscles. As a result, pyridostigmine (Mestinon) helps more acetylcholine stay in your body to activate your muscles. This helps lessen muscle weakness.

Drug facts

Common BrandsMestinon
Drug ClassAcetylcholinesterase inhibitor
Controlled Substance ClassificationNot a controlled medication
Generic StatusLower-cost generic available
AvailabilityPrescription only
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Side effects of Pyridostigmine (Mestinon)

The following side effects may get better over time as your body gets used to the medication. Let your healthcare provider know immediately if you continue to experience these symptoms or if they worsen over time.

Common Side Effects

See Risks and Warnings.

Less Common Side Effects

These side effects are usually from taking too much pyridostigmine:

  • Nausea
  • Vomiting
  • Diarrhea
  • More bowel movements
  • Stomach cramps
  • More saliva
  • More phelgm in the airways
  • Small pupil size
  • Sweating
  • Muscle cramps
  • Muscle twitching
  • Muscle weakness

Pyridostigmine (Mestinon) serious side effects

Contact your healthcare provider immediately if you experience any of the following.

  • Myasthenic crisis: severe muscle weakness, trouble breathing

Source: DailyMed

The following Pyridostigmine (Mestinon) side effects have also been reported

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if any of the following side effects occur:

Symptoms of overdose

Blurred vision

clumsiness or unsteadiness

confusion

convulsions (seizures)

diarrhea (severe)

increase in bronchial secretions or watering of mouth (excessive)

increasing muscle weakness (especially in the arms, neck, shoulders, and tongue)

muscle cramps or twitching

nausea or vomiting (severe)

shortness of breath, troubled breathing, wheezing, or tightness in chest

slow heartbeat

slurred speech

stomach cramps or pain (severe)

unusual irritability, nervousness, restlessness, or fear

unusual tiredness or weakness

Check with your doctor as soon as possible if any of the following side effects occur:

Rare

Redness, swelling, or pain at place of injection (for pyridostigmine injection only)

skin rash (does not apply to ambenonium)

Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

More common

Diarrhea

increased sweating

increased watering of mouth

nausea or vomiting

stomach cramps or pain

Less common

Frequent urge to urinate

increase in bronchial secretions

unusually small pupils

unusual watering of eyes

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

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Pros and cons of Pyridostigmine (Mestinon)

Pros

  • First-choice treatment for myasthenia gravis
  • Available as an oral solution if you need small dose changes or have trouble swallowing pills
  • Available as a lower-cost generic form

Cons

  • Doesn't cure myasthenia gravis
  • Might need to take multiple times a day (especially for immediate-release tablets and oral solution)
  • Can't use if you have urinary or intestinal blockage
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Pharmacist tips for Pyridostigmine (Mestinon)

pharmacist
  • You can take pyridostigmine (Mestinon) with or without food. If it upsets your stomach, try taking it with food to help.
  • For the extended-release tablet: Swallow the extended-release tablet whole. Don't chew, break, or crush the medication. You might also need to take the faster-acting, immediate-release tablet or oral solution to help provide enough symptom relief throughout the day.
  • Contact your provider if you can't take your usual dose of pyridostigmine (Mestinon) because of any vomiting or because you're having trouble swallowing. Also, seek medical help right away if you become severely weak, especially if it starts getting hard to breathe.
  • Don't stop taking pyridostigmine (Mestinon) unless your provider told you to do so. Pyridostigmine (Mestinon) is usually a much-needed medication for people with myasthenia gravis. You can have serious muscle weakness if you stop taking it or skip too many doses.
  • Talk to your provider if you become pregnant during treatment with pyridostigmine (Mestinon). There isn't enough information to know whether this medication is safe during pregnancy or while you're breastfeeding.

More tips for pyridostigmine (Mestinon) liquid:

  • Store the medication bottle at room temperature.
  • Make sure to only use a medication dose cup or oral syringe from the pharmacy to measure out your dose. Don't use household spoons because they aren't accurate and might cause you to take the wrong dose.
  • The pyridostigmine (Mestinon) liquid contains 5% alcohol. Talk to your provider if this concerns you.
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Common questions about Pyridostigmine (Mestinon)

It takes about 15 to 30 minutes for pyridostigmine (Mestinon) to start working. Talk to your provider about your treatment plan to make sure you're getting the most out of the medication to help with muscle weakness throughout the day.

The effects of the immediate-release tablet and oral solution usually last for 3 to 4 hours. This is why the medication is typically taken multiple times throughout the day. But the extended-release form of pyridostigmine (Mestinon) might last a little bit longer. Your healthcare provider can work with you to figure out the dosing schedule that works best for you.

Take pyridostigmine (Mestinon) by mouth by swallowing the medication. The immediate-release tablets and oral solution are typically taken many times throughout the day to help maintain muscle strength. And the extended-release tablets are taken once or twice a day (at least 6 hours apart). Your provider will discuss a treatment plan that works best for you. Depending on your daily activities, your provider might suggest that you take pyridostigmine (Mestinon) or a slightly higher dose of the medication right before you need muscle strength the most (e.g., run errands, exercise). Check in with your provider on a regular basis to make sure that you're getting the most out of the medication and that you're taking it safely.

The manufacturer doesn't specify whether pyridostigmine (Mestinon) tablets can be crushed. As a general rule, the pyridostigmine (Mestinon) extended-release tablets shouldn't be crushed, chewed, broken, or split in half to make sure the medication works as it should and is safe for you. Ask your provider about switching you to the oral liquid if you're having trouble swallowing the tablets.

Alcohol doesn't appear to interact or affect how well pyridostigmine (Mestinon) works. But it's recommended to limit alcohol while you're taking pyridostigmine (Mestinon) because it can worsen certain side effects, like nausea, vomiting, and stomach upset. Talk to your provider about your alcohol consumption habits. Your provider can discuss with you about limiting or avoiding alcohol while you're taking pyridostigmine (Mestinon).

Pyridostigmine (Mestinon) doesn't appear to cause weight gain or weight loss. Talk to your provider if you notice unexpected changes in your weight so you can be examined for a more serious medical problem.

Not really. Pyridostigmine (Mestinon) doesn't typically increase (raise) the blood pressure throughout your body. In addition, a rise in blood pressure or hypertension wasn't a reported side effect in people taking the medication during clinical studies. But because of how pyridostigmine (Mestinon) works to improve communication between nerves in the body, some researchers suggest that the medication can help your body's reflexes to maintain blood pressure when you stand after sitting or lying down. This might prevent your blood pressure from getting too low from this change in position (called orthostatic hypotension).

No, pyridostigmine (Mestinon) isn't an anticholinergic medication. Instead, pyridostigmine (Mestinon) is a cholinesterase inhibitor; it raises the levels of acetylcholine in the body to help relieve muscle weakness from myasthenia gravis. Anticholinergics do the opposite; they block acetylcholine from working.

No, pyridostigmine (Mestinon) isn't a steroid. Instead, pyridostigmine (Mestinon) is a cholinesterase inhibitor; it raises the levels of acetylcholine in the body to help with muscle weakness from myasthenia gravis. Steroids can also be used to help with myasthenia gravis symptoms by lowering the activity of the immune system to lessen inflammation. Depending how severe your condition is, it's possible you might need to take both pyridostigmine (Mestinon) and a steroid.

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Risks and warnings for Pyridostigmine (Mestinon)

Pyridostigmine (Mestinon) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.

Myasthenic crisis

Taking too much pyridostigmine (Mestinon) can cause muscle weakness. However, muscle weakness is also a sign of worsening myasthenia gravis. It can be hard to tell whether you're taking too much or too little pyridostigmine (Mestinon). Yet, both situations are potentially life-threatening if your lungs become too weak to breathe. Keep in mind that myasthenic crisis can happen when your muscles feel severely weak, even though you've been taking pyridostigmine (Mestinon) as prescribed.

Call your provider right away if you have any muscle weakness to figure out whether you need to take less or more of pyridostigmine (Mestinon). Your provider can help identify the cause of your muscle weakness and treat the symptoms. Seek medical attention right away if you become severely weak or have trouble breathing.

Caution use in people with asthma

Muscle weakness can be a sign of worsening myasthenia gravis or a sign that you've taken too much pyridostigmine (Mestinon). Muscle weakness can be dangerous if it makes your lungs too weak to breathe. For this reason, pyridostigmine (Mestinon) should be used with caution in people with asthma. Tell your provider if you have any lung or breathing problems before you start pyridostigmine (Mestinon). Get medical help right away if you have trouble breathing while you're taking this medication.

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Pyridostigmine (Mestinon) dosage

The average cost for 90 tablets of 60mg of Pyridostigmine (Mestinon) is $33.92 with a free GoodRx coupon. This is 74.04% off the average retail price of $130.64.
bottle of oral solutionBottle of oral solution
DosageQuantityPrice as low asPrice per unit
473ml of 60mg/5ml1 bottle$174.96$174.96
tabletTablet
DosageQuantityPrice as low asPrice per unit
60mg90 tablets$33.92$0.38
30mg21 tablets$45.98$2.19

Typical dosage for Pyridostigmine (Mestinon)

  • Immediate-release tablets and 60 mg/5 mL oral solution (liquid): The typical dose is 600 mg by mouth per day. People with mild myasthenia gravis might only need 60 mg to 360 mg per day. But those with more severe myasthenia gravis might need up to 1,500 mg per day. Your provider will help you space out your total dose throughout the day.
  • Extended-release tablets: The typical dose is 180 mg to 540 mg by mouth once or twice daily. The doses should be separated by at least 6 hours.

Your provider will adjust your dose based on how well it's helping your condition, whether you have kidney problems, and whether you're having side effects.

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Interactions between Pyridostigmine (Mestinon) and other drugs

Pyridostigmine (Mestinon) may interact with certain medications or supplements. Always let your doctor and pharmacist know about any other medications or supplements (including prescribed and over-the-counter medications, vitamins, and dietary or herbal supplements) that you are currently taking. The list below does not include all possible drug interactions with Pyridostigmine (Mestinon). Please note that only the generic name of each medication is listed below.

Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking any of these medicines, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using medicines in this class with any of the following medicines is not recommended. Your doctor may decide not to treat you with a medication in this class or change some of the other medicines you take.

Using medicines in this class with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

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How much does Pyridostigmine (Mestinon) cost?

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Pyridostigmine (Mestinon) contraindications

Contraindications are specific health conditions or situations in which a person should not take a medication due to safety concerns. If you have any of the following conditions or if any of the following apply to you, let your healthcare provider know because Pyridostigmine (Mestinon) will not be safe for you to take.

  • Intestinal or urinary blockage
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Pyridostigmine (Mestinon) images

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References

Best studies we found

Acella Pharmaceuticals, LLC. (2023). Pyridostigmine bromide solution [package insert]. DailyMed.

Farmakidis, C., et al. (2018). Treatment of myasthenia gravis. Neurologic Clinics.

Farrugia, M. E., et al. (2020). A practical approach to managing patients with myasthenia gravis-Opinions and a review of the literature. Frontiers in Neurology.

GoodRx Health has strict sourcing policies and relies on primary sources such as medical organizations, governmental agencies, academic institutions, and peer-reviewed scientific journals. Learn more about how we ensure our content is accurate, thorough, and unbiased by reading our editorial guidelines.

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