Sometimes our muscles feel like they're lifeless, don't they? Our eyelids droop, we have difficulty speaking and swallowing, and our limbs feel numb. Today we're talking about a special medicine that treats a condition called Myasthenia Gravis, which has symptoms like these. That medicine is Pyridostigmine.
What is Pyridostigmine?
Simply put, Pyridostigmine is a drug that helps your muscles regain lost strength. Our body's nerves and muscles communicate through a chemical. In the case of 'Myasthenia Gravis', this communication is disrupted. Pyridostigmine works by overcoming that disruption and restoring communication between the nerves and muscles.
Your doctor may prescribe this medication under brand names like Mestinon or Mestinon Timespan. 'Timespan' or 'extended-release' refers to the type that is absorbed into the body more slowly and stays active for a longer period of time.
Things you need to tell your doctor before taking this medicine
Okay, now before starting this medication, it is very important that your doctor is fully aware of your health condition. If you have any of the medical conditions below, be sure to tell them about it.
| Medical condition/other matters | Why should you inform? |
|---|---|
| Asthma | Pyridostigmine can further constrict the airways and increase breathing difficulty. |
| Heart disease or slow heartbeat | This medicine may further slow down the heart rate. |
| Difficulty or obstruction in urinating | This situation may worsen. |
| Stomach ulcers or intestinal obstructions | Stomach pain and other gastrointestinal problems may increase. |
| Kidney disease | Since the medicine is eliminated from the body by the kidneys, the dosage may need to be adjusted. |
| Abdominal infections (e.g. Peritonitis) | Symptoms can be subtle and diagnosis can be difficult. |
| Being pregnant or trying to get pregnant | The doctor will determine if the child is affected. |
| Breastfeeding | It is important to consider whether the medicine is passing to the baby through breast milk. |
| Allergies to other medicines, foods or substances | This is important to assess the risk of developing an allergy to the medication. |
How should I use this medicine?
Keep these points in mind when using this medicine:
- Swallow this pill whole with a glass of water.
- Do not break, crush, or chew the pill, especially if it is an 'extended-release' (Timespan) type, as this can cause the medicine to enter the body too quickly and cause side effects.
- Take the exact dose, exactly as prescribed by your doctor. Your doctor will tell you how many times a day and how much to take.
- Never stop taking your medication suddenly without your doctor's advice. Doing so may cause symptoms (e.g., difficulty swallowing, difficulty breathing) to suddenly worsen.
- If this medicine is given to children, special care is required and it should be done only on medical advice.
Important: If you think you have taken more than the recommended dose, call your doctor immediately.Call the National Poisons Information Centre at the Colombo National Hospital, or go to the Emergency Treatment Unit (ETU) of the nearest hospital.
What to do if you miss a dose of medication?
Take the missed dose as soon as you remember. However, if it is almost time for your next dose, skip the missed dose and take your next dose at the scheduled time. Do not take a double dose for any reason!
Other things that may interact with this medicine
It is very important to tell your doctor about every medication, vitamin, and nutritional supplement you are taking, as Pyridostigmine can interact with some medications.
| Nature of the collision | Examples (types of medicine) |
|---|---|
| Do not take Pyridostigmine with this medicine. | |
| Because the actions are similar, side effects may increase. | Other medications for myasthenia gravis (e.g. neostigmine), Quinine. |
| Please inform your doctor as this may interact with your medication. | |
| Pyridostigmine may decrease or increase its effectiveness or cause side effects. | atropine, bethanechol, disopyramide, edrophonium, guanethidine, mecamylamine, and some medications that control muscle or nerve pain. |
This list is not complete, so it's safest to tell your doctor about anything you're taking.
Things to keep in mind when taking medication
- See your doctor at the scheduled time to check your condition. If your symptoms persist or worsen, tell your doctor.
- It is very important to carry a medical ID that states that you have Myasthenia Gravis and the medications you are taking and their dosages. This can be very helpful in an emergency.
What are the possible side effects?
Like any medicine, Pyridostigmine can cause some side effects. However, not everyone gets them. Let's take a look at what these are.
| Side effect | What to do |
|---|---|
| If any of these occur, tell your doctor immediately. | |
| Allergic reactions (skin rash, itching, swelling of the face/lips/tongue) | Seek medical advice immediately. |
| Difficulty breathing | |
| Vision changes | |
| Severe muscle pain, cramps, or limping | |
| Heartbeat that is very slow or irregular | |
| Severe stomach pain, vomiting | |
| Unusual tiredness or weakness | |
| These are usually not dangerous, but if they persist, tell your doctor. | |
| Diarrhea (especially at the beginning of treatment) | If the condition persists, inform the doctor. |
| Excessive salivation | |
| Increased sweating, nausea | |
How should you store your medicine?
- Keep it in a safe place out of reach of children.
- Store at room temperature (between 15-30 Celsius). Protect from excessive heat or cold.
- Protect from moisture and direct sunlight. Keep the medicine bottle tightly closed.
- Discard expired medication without using it.
Take-Home Message
- Pyridostigmine is a medication used to treat the muscle weakness disease Myasthenia Gravis.
- Before starting this medication, tell your doctor about all other medical conditions you have (especially asthma, heart disease, kidney disease).
- Swallow the pill whole, without breaking or crushing it. Take it at the prescribed time.
- Do not stop taking the medication suddenly without your doctor's advice.
- If you experience any serious side effects, such as difficulty breathing, severe muscle pain, or slow heartbeat, contact your doctor immediately.
- Tell your doctor about all other medications you are taking. This is very important for your safety.
👩🏽⚕️ Additional questions (FAQs)
💬 What is Pyridostigmine / Mestinon used for?
This is a very important and main pill given for the severe neuromuscular disease called 'Myasthenia Gravis'! When the signals from our brain stop reaching the muscles, our muscles become paralyzed (we can't open our eyes, talk, or walk). What this pill does is restore the strength of those muscles that are being lost and bring the patient back to normal.
💬 How does this medicine (Pyridostigmine / Mestinon) stimulate muscles?
The message to a muscle is sent from our brain through the nerves by a chemical called 'Acetylcholine'. But in patients with Myasthenia, these are quickly destroyed (by the Cholinesterase enzyme). After taking this medicine, the destroying enzyme is blocked (Cholinesterase inhibitor), and more acetylcholine is allowed to accumulate near the muscles. Then the muscles can work/contract normally/strongly again.
💬 What are the annoying side effects that can occur when taking this medicine?
This not only revitalizes the muscles, but also greatly increases the activity of internal organs such as the intestines/bladder! Therefore, drinking this can definitely cause annoying side effects such as 'severe diarrhea, severe stomach pain, salivation/tearing from the mouth/eyes, and frequent urination'. (Also, if the dose is increased, the muscles may collapse/become inactive!)
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