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Manufacturer(s) of Pyridostigmine (Br) in Pakistan.

Life LineOtsukaShifa

Pyridostigmine (Br)


Pyridostigmine (Br) is a quaternary ammonium cholinesterase inhibitor. Pyridostigmine (Br) is a muscular stimulant. It has longer duration of action than that of neostigmine. Pyridostigmine (Br) is used in the chronic management of myasthenia gravis.Pyridostigmine (Br) is also used to reverse the actions of nondepolarizing neuromuscular blockers after surgery. Pyridostigmine was approved by the FDA in 1955.


Primary Characterstics

Molecular Structure of Pyridostigmine (Br)
. It is of Synthetic origin and belongs to Quaternary Ammonium. It belongs to Cholinestrase inhibitor pharmacological group on the basis of mechanism of action and also classified in Antidotes and Cholinergic Agonist pharmacological group.The Molecular Weight of Pyridostigmine (Br) is 261.10.
It is weakly alkaline drug, 4.13% solution of the drug is isotonic and Its pKa is strongly basic.


Oral absorption of Pyridostigmine (Br) is found to be 45.5% ±4.5. Volume of distribution is found to be 0.53 - 1.8 l/kg and plasma protien binding is negligible. Renal Excretion accounts for 90% and plasma half life is 0.38 - 1.9 hr.


Pyridostigmine (Br) is primarily indicated in conditions like Myasthenia gravis, Paralytic ileus, Urinary retention, Urinary retention.


Pyridostigmine (Br) is contraindicated in conditions like Intestinal obstruction,Urinary obstruction.

Drug Interactions

Pyridostigmine (Br) is known to interact with other drugs, the details of drug interactions is as follows:

Colistin (Sulphate & Sulphomethate Na)
Hydroxychloroquine (Sulphate)
Hydroxychloroquine (Sulphate)
Kanamycin (Acid Sulphate)
Lithiumlithium interfere with neuromuscular conduction
MethocarbamolMethocarbamol may inhibit the effect of pyridostigmine bromide. Methocarbamol should be used with caution in patients with myasthenia gravis receiving anticholinesterase agents.
Methylprednisolonecoadministration with corticosteroids such as methylprednisolone result in profound weaknessventilation
Oxytetracycline (Dihydrate)
Pantothenic AcidPantothenic Acid may increase the effects of Pyridostigmine (Br).
Penicillaminecoadministration may develop myasthenia gravis
Polymyxin B (Sulphate)
Procainamide (HCl)
Procainamide (HCl)Antiarrythmic drugs such as procainamide block the acetylcholine receptor
Propafenone (HCl)
Propranolol (HCl) coadministration with beta blockers have the potential to aggravate the symptom of myasthenia gravis and also reports of bradycardia and hypotensionventilation
QuinidineAntiarrythmic drugs such as quinidine block the acetylcholine receptor
Trimeprazine (Tartrate)
Verapamil (HCl)coadministration with ca channel blockers such as verapamil may produce an enhance muscle block.manage with Edrophonium

These interactions are sometimes beneficial and sometimes may pose threats to life. Always consult your physician for the change of dose regimen or an alternative drug of choice that may strictly be required.

Interference in Pathology

No data regarding the pathological interferences produced by Pyridostigmine (Br) is available.

Side Effects

The severe or irreversible adverse effects of Pyridostigmine (Br), which give rise to further complications include Hallucinations, Anxiety, Epilepsy, Disorientation, Loss of consciousness.

The signs and symptoms that are produced after the acute overdosage of Pyridostigmine (Br) include Bradycardia, Diarrhea, Dizziness, Sweating, Abdominal pain, Salivation, Depolarizing block.

The symptomatic adverse reactions produced by Pyridostigmine (Br) are more or less tolerable and if they become severe, they can be treated symptomatically, these include SweatingX.

Available Brands

Click on the appropriate strength of the dosage form to view its available brands.

Single Ingredient

Tabs: 60 mg,

Multi ingredient

Inj: 0.5 mg/ml, 100 mg/3ml,
Inf: 40 mg/L,
Syrup: 1 mg/5ml,
Tabs: 100 mg,
Caps: 3 mg,


Pyridostigmine (Br)'s dosage details are as follows:
Dose Single Dose Frequency Route Instructions

Adult Dosage

2 to 5 mg/dose3.5 (3.5)2.4 hourlyIV,IM
60 to 180 mg120 (120)As recommended.POIn Divided doses for Myasthenia Gravis
300 to 1200 mg750 (750)As recommended.POIn Divided doses for Myasthenia Gravis

Paedriatic Dosage ( 20 Kg. )

3 mg/kg3 (3)6 hourlyOralAdjust Dose as per response obtained

Neonatal Dosage ( 3 Kg. )

0.625 to 3.75 mg/kg2.2 (2.1875)6 hourlyOralInitial dose , then adjust according to response

High Risk Groups

If prescribing authority justifies the benefits of the drug against the possible damages he/she should reevaluate them and consult the reference material and previous studies.

Warning / Precautions

Pyridostigmine should be used with caution in patients with any pre-existing stomach disorders, kidney or urinary problems, ulcers, asthma, epilepsy, heart diseases, thyroid disorders or allergies especially to bromides or anticholinesterases. Notify the doctor if this medication appears to be losing its effect. In some cases, people become insensitive to the medication and it must be stopped for a brief period. It should be used only if clearly needed during pregnancy or lactation.

Storage Conditions


Store Between 15°C-30°C. Do not Freeze. Protect from Sunlight and Moisture.


Store Between 15°C-30°C. Protect from Sunlight and Moisture.

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