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This safety information outlines crucial warnings and precautions related to the use of pyridostigmine (Mestinon). It is essential to understand these aspects to ensure safe and effective usage of the medication. Please consult your healthcare provider if you have any questions or concerns.

• Myasthenic Crisis: Excessive intake of pyridostigmine (Mestinon) can lead to muscle weakness, which is also a symptom of worsening myasthenia gravis. Differentiating between the two can be challenging, but both conditions can be life-threatening if respiratory muscles become too weak. A myasthenic crisis may occur even when taking the medication as directed. Seek immediate medical attention if you experience severe muscle weakness or difficulty breathing.

• Caution for Asthma Patients: Pyridostigmine (Mestinon) should be used cautiously in individuals with asthma, as muscle weakness can impair breathing. Notify your healthcare provider of any respiratory issues before starting treatment. If you experience breathing difficulties while on this medication, seek urgent medical care.

• Contraindications: Do not use pyridostigmine (Mestinon) if you have an intestinal or urinary obstruction, as it can pose significant health risks. Consult your healthcare provider if you have these conditions before using this medication.

Common side effects:

• nausea
• vomiting
• diarrhea
• increased bowel movements
• abdominal cramps
• increased saliva or phlegm production
• smaller pupil size
• increased sweating
• muscle cramps
• muscle twitching
• muscle weakness

Serious side effects:

• myasthenic crisis
• allergic reaction
• rash
• itching
• swelling of the face, tongue, or throat
• severe dizziness
• trouble breathing

When taking pyridostigmine extended-release (ER) tablets, it's important to be aware of potential interactions with other medications, as these can affect how pyridostigmine works or increase the risk of side effects. Here are some notable interactions:

Beta-Blockers: Combining pyridostigmine with beta-blockers may enhance bradycardia (slow heart rate).

Corticosteroids: Using corticosteroids alongside pyridostigmine can lead to increased muscle weakness in individuals with myasthenia gravis. It's advisable to discontinue pyridostigmine at least 24 hours before starting corticosteroid therapy.

Aminoglycoside Antibiotics: Antibiotics like gentamicin and Streptomycin may intensify neuromuscular blockade, potentially worsening muscle weakness. These should be used cautiously, if at all, in patients taking pyridostigmine.

Local and General Anesthetics: Some anesthetics can interfere with neuromuscular transmission, possibly diminishing the effectiveness of pyridostigmine. Inform your healthcare provider if you are scheduled for surgery or procedures requiring anesthesia.

Antiarrhythmic Agents: Medications used to treat irregular heartbeats may interact with pyridostigmine, affecting its efficacy. Consult your doctor if you're on such treatments.

Other Cholinesterase Inhibitors: Combining pyridostigmine with other cholinesterase inhibitors can lead to additive effects, increasing the risk of side effects.

Depolarizing Neuromuscular Blocking Agents: Pyridostigmine may prolong the effects of depolarizing muscle relaxants like succinylcholine, leading to extended muscle relaxation.

Non-Depolarizing Neuromuscular Blocking Agents: The effectiveness of non-depolarizing muscle relaxants may be reduced when used with pyridostigmine, possibly requiring dosage adjustments.

Anticholinergic Medications: Drugs such as atropine can counteract the muscarinic effects of pyridostigmine, potentially altering its therapeutic impact.

Drugs Converted to Pantothenic Acid: Medications like dexpanthenol may have additive effects when taken with pyridostigmine, increasing acetylcholine production.

Always inform your healthcare provider about all medications, supplements, or herbal products you are currently using to ensure safe and effective use of pyridostigmine ER tablets.