1. Pyridostigmine for MG Richard J. Barohn, MD
Richard J. Barohn, MD
Chair, Department of Neurology
Gertrude and Dewey Ziegler Professor of Neurology
University Distinguished Professor
Vice Chancellor for Research
University of Kansas Medical Center
Kansas City, KS

2. Treatment of MG Cholinesterase Inhibitors
Pyridostigmine (Mestinon)
Prostigmine (Neostigmine)
Immunosuppressive Drug Therapies
Plasmapheresis
Surgery
Thymectomy

3. Mary Walker
Walker MB. Treatment of Myasthenia Gravis With Physostigmine. Lancet. 1934

4. Walker MB. Case showing the effects of Prostigmin on Myasthenia Gravis
Walker MB. Case showing the effects of Prostigmin on Myasthenia Gravis. Proceedings of the Royal Society of Medicine. 1934

5. Mestinon (Pyridostigmine) for Myasthenia Gravis
Osserman KE, Teng P, Kaplan LI. Studies in myasthenia gravis. Preliminary report on therapy with Mestinon bromide. JAMA 1954;155:
20 pts on neostigmine changed to mestinon.
15/20 found it more effective
Westberg MR, Magee KR. Mestinon in the treatment of myasthenia gravis. Neurology 1954;4:
22 pts on neostigmine switched to mestinon
19 preferred it
Tether JE. Mestinon in myasthenia gravis (preliminary report). Dis Nerv Syst 1954;15:
56 pts; daily dose ,800 mg
Schwab RS, Timberlake WH. Pyridostigmin (Mestinon) in the treatment of myasthenia gravis. N Engl J Med 1954;251:
No better than neostigmine

6. Pyridostigmine (Mestinon)
1st Line Rx for MG
Don’t expect or use too much
60 mg TID - QID
If need more than this, immunosuppressive Rx needed
Generic now available
Avoid time-release form
Anticholinergic meds useful for GI side effects:
Hyoscyamine Sulfate mg (Levsin/Anaspaz)
No randomized controlled trial but comparative effect studies!
Only FDA drug approved for MG
Cholinergic crisis tries not exist in 2016!