www rrnmf com Pyridostigmine for MG Richard J

www. rrnmf. com Pyridostigmine for MG 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

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

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

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

Mestinon (Pyridostigmine) for Myasthenia Gravis 1. Osserman KE, Teng P, Kaplan LI. Studies in myasthenia gravis. Preliminary report on therapy with Mestinon bromide. JAMA 1954; 155: 961 -965 • 20 pts on neostigmine changed to mestinon. • 15/20 found it more effective 2. Westberg MR, Magee KR. Mestinon in the treatment of myasthenia gravis. Neurology 1954; 4: 762 -771 • 22 pts on neostigmine switched to mestinon • 19 preferred it 3. Tether JE. Mestinon in myasthenia gravis (preliminary report). Dis Nerv Syst 1954; 15: 227 -231 • 56 pts; daily dose 75 - 4, 800 mg 4. Schwab RS, Timberlake WH. Pyridostigmin (Mestinon) in the treatment of myasthenia gravis. N Engl J Med 1954; 251: 271 -272 • No better than neostigmine

Pyridostigmine (Mestinon) • 1 st 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 0. 125 mg (Levsin/Anaspaz) No randomized controlled trial but comparative effect studies! • Only FDA drug approved for MG • Cholinergic crisis tries not exist in 2016!