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Pyridostigmine

Generic Name
Pyridostigmine
Brand Names
Mestinon, Regonol
Drug Type
Small Molecule
Chemical Formula
C9H13N2O2
CAS Number
155-97-5
Unique Ingredient Identifier
19QM69HH21
Background

Myasthenia gravis is an autoimmune disease involving dysfunction at the neuromuscular junction, most commonly due to autoantibodies directed against the acetylcholine receptor (AChR), which results in muscle tone loss, muscle weakness, and fatigue. Acetylcholinesterase inhibitors have been the symptomatic treatment of choice in myasthenia gravis since the 1930s with the early use of physostigmine and neostigmine. By inhibiting the breakdown of acetylcholine in the neuromuscular junction, they increase signalling and relieve symptoms. Pyridostigmine is the current drug of choice, with superior pharmacokinetics and reduced side effects compared to neostigmine. In addition to treating myasthenia gravis, pyridostigmine is used to reverse neuromuscular blocks, relieve symptoms in congenital myasthenic syndromes, and protect against certain nerve agents, notably during the Gulf War.

Pyridostigmine was granted initial FDA approval on April 6, 1955, as an oral tablet. Possible dose forms have been expanded to include extended-release tablets, syrups, and injections, marketed under various brand and generic names.

Indication

Pyridostigmine is indicated for the treatment of myasthenia gravis. When administered intravenously, it is indicated for the reversal or antagonism of the neuromuscular blocking effects of nondepolarizing muscle relaxants.

Pyridostigmine has also been used as a prophylactic agent against irreversible organophosphorus acetylcholinesterase inhibitors, primarily in a military capacity.

Associated Conditions
Congenital Myasthenia (CM), Constipation, Myasthenia Gravis, Neuromuscular Blockade, Post-Poliomyelitis Syndrome, Orthostatic syncope, Soman nerve gas poisoning
Associated Therapies
-

LIFT: Life Improvement Trial

Phase 2
Not yet recruiting
Conditions
ME/CFS
Interventions
First Posted Date
2024-04-16
Last Posted Date
2024-07-25
Lead Sponsor
Brigham and Women's Hospital
Target Recruit Count
160
Registration Number
NCT06366724

Addition of Pyridostigmine to Conventional Management of Postdural Puncture Headache

Phase 4
Completed
Conditions
Postdural Puncture Headache
Interventions
First Posted Date
2023-08-01
Last Posted Date
2024-01-09
Lead Sponsor
Ain Shams University
Target Recruit Count
30
Registration Number
NCT05969119
Locations
🇪🇬

Suez General Hospital, Suez, Egypt

Pyridostigmine and Amifampridine for Myasthenia Gravis

Phase 3
Recruiting
Conditions
Myasthenia Gravis
Interventions
First Posted Date
2023-06-26
Last Posted Date
2023-06-26
Lead Sponsor
Leiden University Medical Center
Target Recruit Count
24
Registration Number
NCT05919407
Locations
🇳🇱

Leiden University Medical Center, Leiden, South-Holland, Netherlands

Pyridostigmine for the Treatment of Constipation in Parkinson Disease

Phase 2
Recruiting
Conditions
Parkinson Disease
Constipation
Interventions
First Posted Date
2022-11-03
Last Posted Date
2023-06-18
Lead Sponsor
University of Vermont Medical Center
Target Recruit Count
16
Registration Number
NCT05603715
Locations
🇺🇸

University of Vermont Medical Center, Burlington, Vermont, United States

Pyridostigmine Efficacy and Safety for Treatment of Ileus After Colorectal Surgery

Phase 2
Recruiting
Conditions
Postoperative Ileus
Interventions
First Posted Date
2022-04-19
Last Posted Date
2024-11-12
Lead Sponsor
Stefan Holubar MD MS FACS, FASCRS
Target Recruit Count
50
Registration Number
NCT05334485
Locations
🇺🇸

Cleveland Clinic Main Campus, Cleveland, Ohio, United States

Effects of Vagal Dysfunction on Gastrointestinal and Inflammatory Pathways in HIV

Phase 1
Recruiting
Conditions
HIV
Non-HIV
Vagus Nerve Dysfunction
Interventions
Drug: Pyridostigmine
Drug: Placebos
Procedure: non-invasive vagal nerve stimulation
First Posted Date
2020-04-20
Last Posted Date
2024-02-02
Lead Sponsor
Icahn School of Medicine at Mount Sinai
Target Recruit Count
150
Registration Number
NCT04353778
Locations
🇺🇸

Icahn School of Medicine at Mount Sinai, New York, New York, United States

Pyridostigmine in Severe SARS-CoV-2 Infection

Phase 2
Conditions
COVID-19
SARS-CoV-2
Interventions
First Posted Date
2020-04-14
Last Posted Date
2020-07-07
Lead Sponsor
Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran
Target Recruit Count
436
Registration Number
NCT04343963
Locations
🇲🇽

Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, Tlalpan, Mexico

The Exercise Response to Pharmacologic Cholinergic Stimulation in Myalgic Encephalomyelitis / Chronic Fatigue Syndrome

Phase 2
Completed
Conditions
Myalgic Encephalomyelitis/Chronic Fatigue Syndrome
Chronic Fatigue Syndrome
Myalgic Encephalomyelitis
Exercise Intolerance
Dysautonomia
Low Ventricular Filling Pressures (Preload Failure)
Postural Orthostatic Tachycardia Syndrome
Fibromyalgia
Orthostatic Hypotension
Interventions
First Posted Date
2018-09-17
Last Posted Date
2022-11-08
Lead Sponsor
Brigham and Women's Hospital
Target Recruit Count
45
Registration Number
NCT03674541
Locations
🇺🇸

Brigham and Women's Hospital, Boston, Massachusetts, United States

Effect of Pyridostigmine (Mestinon) on Muscle Strength in Myasthenia Gravis

Phase 4
Conditions
Myasthenia Gravis
Interventions
Drug: Pyridostigmine
Drug: Placebo oral capsule
First Posted Date
2018-04-27
Last Posted Date
2018-04-27
Lead Sponsor
University of Aarhus
Target Recruit Count
44
Registration Number
NCT03510546
Locations
🇩🇰

Department of Neurology Aarhus University Hospital, Aarhus, Midtjylland, Denmark

Pyridostigmine as Immunomodulator in People Living With HIV

Phase 2
Suspended
Conditions
CD4+ T Lymphocytopenia
HIV-1-infection
Immune Deficiency
Immuno-senescence
Interventions
First Posted Date
2017-10-17
Last Posted Date
2020-04-10
Lead Sponsor
Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran
Target Recruit Count
60
Registration Number
NCT03312244
Locations
🇲🇽

Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, Tlalpan, Mexico

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