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治療重症肌無力症 Myasthenia gravis

Acetylcholinesterase Inhibitor
Pyridostigmine is an anticholinesterase agent that inhibits the hydrolysis of acetylcholine by competing with acetylcholine for attachment to acetylcholinesterase.

Absorption:
1. Poorly absorbed from the GI tract
2. Bioavailability: 10–20%
3. Onset of action: 30–45 minutes after oral administration; Duration of action: 3–6 hours.
Metabolism:
Hydrolysis by cholinesterases; the drug also is metabolized by microsomal enzymes in the liver
Excretion:
80–90%; unchanged by the kidneys
Elimination half-life:
1.05–1.86 hour (in patients with normal renal function); 6.3 hours(in anephric patients)

1. Hypersensitivity to pyridostigmine, anticholinesterase agents, or any component of the formulation
2. Mechanical intestinal or urinary obstruction; bronchial asthma; coronary occlusion
3. History of reaction to bromide

C
Oral pyridostigmine is the agent of choice for treating myasthenia gravis during pregnancy

Current guidelines note that breastfeeding is acceptable for myasthenia gravis (UTD)
Probably safe, if dose is in the range of 120-300mg and infant with normal renal function (Micromedex)

Nausea, vomiting, abdominal cramps, miosis, increase salivation and bronchial secretion, bradycardia, hypotension

60-180mg daily divided into 2-4 doses (Manufacturer's labeling)

Limited data available

There are no dosage adjustments provided in the manufacturer's labeling. However, lower initial doses dosages may be required due to prolonged elimination in renal impairment.

There are no dosage adjustments provided in the manufacturer's labeling.