Pyridostigmine Side Effects

It is possible that some side effects of pyridostigmine may not have been reported. These can be reported to the FDA here. Always consult a healthcare professional for medical advice.

For the Consumer

Applies to pyridostigmine: oral conventional 30-mg tablets for military use, oral conventional 60-mg tablets and extended-release tablets, oral oral solution, parenteral injection

Side effects include:

Diarrhea, abdominal pain or cramps, dysmenorrhea, increased flatus, nausea, urinary urgency and frequency.

For Healthcare Professionals

Applies to pyridostigmine: injectable solution, oral syrup, oral tablet, oral tablet extended release

Gastrointestinal

Gastrointestinal side effects have included nausea, vomiting, diarrhea, loose stools, flatulence, abdominal cramps, increased peristalsis, and increased salivation.

Respiratory

Respiratory side effects have included exacerbation of bronchitis and asthma. Adverse effects that are generally associated with overdosage have included increased bronchial secretions and bronchospasm.

Musculoskeletal

Musculoskeletal side effects have included muscle weakness and twitching. Adverse effects that are generally associated with overdosage have included muscle cramps, fasciculation, weakness, and paralysis. Arthralgia, hyperalgesia and joint pain have been reported.

A 46-year-old woman with myasthenia gravis developed arthralgia, hyperalgesia, and joint stiffness after 8 years of pyridostigmine 60 mg orally 5 times daily. The side effects slightly lessened after lowering dose to 60 mg twice a day. Symptoms disappeared upon discontinuation and returned upon rechallenge.

Endocrine

Endocrine side effects have included diaphoresis and rhinorrhea.

Ocular

Ocular side effects are generally associated with overdosage and have included miosis, lacrimation, and blurred vision.

Dermatologic

Dermatologic side effects have included acneiform skin rashes due to the bromide radical, urticaria, toxic alopecia, and alopecia areata.

Hematologic

Hematologic side effects have included thrombophlebitis after intravenous administration. Individual cases of epistaxis and profuse bleeding after a cut have been reported with oral administration.

Cardiovascular

Cardiovascular side effects have included elevations in blood pressure. Adverse effects that are generally associated with overdosage have included bradycardia, tachycardia, cardiospasm, and hypotension.

Nervous system

Nervous system side effects have included headache, vertigo, and tingling of the extremities. Adverse effects that are generally associated with pyridostigmine overdosage and/or bromide intoxication have included agitation, coma, confusion, combativeness, delusions, hallucinations, incoordination, irritability, loss of memory, restlessness, and stupor.

Genitourinary

Genitourinary effects have included urinary urgency and frequency.

Metabolic

Metabolic side effects have been attributed to bromide intoxication and have included a negative anion gap and hyperchloremia.

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