Identification
- Summary
Pyridostigmine is a cholinesterase inhibitor used for symptomatic treatment of myasthenia gravis and congenital myasthenic syndromes and to reverse neuromuscular blockade by nondepolarizing muscle relaxants.
- Brand Names
- Mestinon, Regonol
- Generic Name
- Pyridostigmine
- DrugBank Accession Number
- DB00545
- Background
Myasthenia gravis is an autoimmune disease involving dysfunction at the neuromuscular junction, most commonly due to autoantibodies directed against the acetylcholine receptor (AChR), which results in muscle tone loss, muscle weakness, and fatigue.2 Acetylcholinesterase inhibitors have been the symptomatic treatment of choice in myasthenia gravis since the 1930s with the early use of physostigmine and neostigmine. By inhibiting the breakdown of acetylcholine in the neuromuscular junction, they increase signalling and relieve symptoms.2,10,11 Pyridostigmine is the current drug of choice, with superior pharmacokinetics and reduced side effects compared to neostigmine.10,11 In addition to treating myasthenia gravis, pyridostigmine is used to reverse neuromuscular blocks, relieve symptoms in congenital myasthenic syndromes, and protect against certain nerve agents, notably during the Gulf War.3,4,11,12
Pyridostigmine was granted initial FDA approval on April 6, 1955, as an oral tablet. Possible dose forms have been expanded to include extended-release tablets, syrups, and injections, marketed under various brand and generic names.10,11
- Type
- Small Molecule
- Groups
- Approved, Investigational
- Structure
Structure for Pyridostigmine (DB00545)
- Weight
- Average: 181.2117
Monoisotopic: 181.09770267 - Chemical Formula
- C9H13N2O2
- Synonyms
- Piridostigmina
- Pyridostigmine cation
Pharmacology
- Indication
Pyridostigmine is indicated for the treatment of myasthenia gravis.10 When administered intravenously, it is indicated for the reversal or antagonism of the neuromuscular blocking effects of nondepolarizing muscle relaxants.11
Pyridostigmine has also been used as a prophylactic agent against irreversible organophosphorus acetylcholinesterase inhibitors, primarily in a military capacity.12
Reduce drug development failure ratesBuild, train, & validate machine-learning modelswith evidence-based and structured datasets.Build, train, & validate predictive machine-learning models with structured datasets.- Associated Conditions
Indication Type Indication Combined Product Details Approval Level Age Group Patient Characteristics Dose Form Symptomatic treatment of Congenital myasthenic syndrome ••• ••••• •••••• •••••• Treatment of Constipation ••• ••••• Symptomatic treatment of Myasthenia gravis •••••••••••• •••••• •••••• Reversal of Neuromuscular blockade •••••••••••• •••••••••• •••••••• Treatment of Postpoliomyelitis syndrome ••• ••••• - Contraindications & Blackbox Warnings
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Pyridostigmine bromide, designated as 3-hydroxy-1-methyl-pyridinium bromide dimethyl-carbamate, is an orally active reversible cholinesterase inhibitor similar to neostigmine but with a milder adverse effect profile and a longer duration of action. Pyridostigmine may, specifically in the case of excessive administration, result in a cholinergic crisis, with symptoms mimicking a myasthenic crisis. Administration of atropine is recommended in the case of a true cholinergic crisis or to counteract muscarinic/nicotinic effects such as bradycardia and excessive bronchial secretions.10,11
- Mechanism of action
Myasthenia gravis is an autoimmune disease involving dysfunction at the neuromuscular junction most commonly due to autoantibodies directed against the acetylcholine receptor (AChR), but also against other targets such as the muscle-specific kinase (MUSK), lipoprotein-related protein 4 (LRP4), or agrin.2 In the case of AChR antibodies, AChRs are directly bound and cross-linked, impairing acetylcholine binding and contributing through various mechanisms to receptor degradation.2 The lack of acetylcholine signalling leads to muscle tone loss, muscle weakness, and fatigue.2
Pyridostigmine is a reversible acetylcholinesterase inhibitor that increases extracellular acetylcholine levels in the neuromuscular junction by impairing its breakdown by acetylcholinesterase.10,11 The increased acetylcholine leads to increased neural transmission across the junction, which drastically improves myasthenia gravis symptoms.2
In addition to its use in myasthenia gravis and in reversing neuromuscular blocks, pyridostigmine is also a common first-line treatment in congenital myasthenic syndromes (CMS), of which there are multiple subtypes caused by mutations in more than 30 distinct genes.3,4 CMS present similarly to myasthenia gravis, albeit due to distinct underlying causes, and often benefit from pyridostigmine. However, in some subgroups, treatment with pyridostigmine is detrimental; detailed genetic testing is required before starting therapy.3,4
Target Actions Organism ACholinesterase inhibitorHumans AAcetylcholinesterase inhibitorHumans - Absorption
Pyridostigmine administered orally is poorly absorbed in the GI tract, with an oral bioavailability of only 10-20%. However, this may in part be due to some metabolism by both the blood and liver.5,12 Approximately 1-2 hours following a single oral dose of 60 mg, the Cmax was determined to be 40-60 μg/L.5 Pyridostigmine follows approximately linear kinetics, with a direct correlation between the dose and plasma AUC.5 Pyridostigmine taken orally with food results in a flatter peak to the plasma concentration vs. time curve. The peak plasma concentrations are reached ~90 minutes later than in fasted subjects but with no change in bioavailability or AUC.6
- Volume of distribution
Pyridostigmine administered intravenously in healthy, myasthenic, and surgical patients has a range of distribution volumes, between 0.53 and 1.76 L/kg.5
- Protein binding
Neither pyridostigmine nor any of its detectable plasma metabolites are appreciably protein-bound.5,12
- Metabolism
Pyridostigmine is hydrolyzed by cholinesterases systemically, including in the blood, and by microsomal enzymes in the liver, though this remains poorly defined. The primary hydrolysis product is 3-hydroxy-N-methyl-pyridinium (HNM), which can be glucuronidated.5,12 One study suggested the existence of as many as eight metabolites in the urine of patients receiving radiolabeled pyridostigmine intravenously, including various glucuronidated, demethylated, and oxidized (quinone) metabolites.7,12 Another study confirmed that HNM is the main metabolite, and suggested additional possible metabolites such as a 3,4- or 3,6-dihydroxy-N-methyl-pyridinium or a methoxy- or acetoxy-N-methyl-pyridinium.8 The exact products formed, apart from HNM, require further validation.
Hover over products below to view reaction partners
- Route of elimination
Pyridostigmine is primarily renally eliminated.11 Roughly 90% of an intravenous dose is recovered in the urine within 24 hours, with unchanged pyridostigmine and its main metabolite HNM recovered in an approximately 4:1 ratio.5,8,12
- Half-life
Pyridostigmine administered intravenously in healthy, myasthenic, and surgical patients has a range of elimination half-lives, between 0.38 and 1.86 hours.5
- Clearance
Pyridostigmine administered intravenously in healthy, myasthenic, and surgical patients has a range of clearance values, between 0.29 and 1.0 L/h/kg.5
- Adverse Effects
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Toxicity information regarding pyridostigmine is not readily available. Patients experiencing an overdose are at an increased risk of severe adverse effects such as bradycardia, excessive bronchial secretions, and cholinergic crisis. Symptomatic and supportive measures are recommended.10,11
- Pathways
- Not Available
- Pharmacogenomic Effects/ADRs Browse all" title="About SNP Mediated Effects/ADRs" id="snp-actions-info" class="drug-info-popup" href="javascript:void(0);">
- Not Available
Interactions
- Drug Interactions Learn More" title="About Drug Interactions" id="structured-interactions-info" class="drug-info-popup" href="javascript:void(0);">
- This information should not be interpreted without the help of a healthcare provider. If you believe you are experiencing an interaction, contact a healthcare provider immediately. The absence of an interaction does not necessarily mean no interactions exist.
Drug Interaction Integrate drug-drug
interactions in your softwareAcebutolol Pyridostigmine may increase the bradycardic activities of Acebutolol. Acetylcholine The risk or severity of adverse effects can be increased when Pyridostigmine is combined with Acetylcholine. Aclidinium Pyridostigmine may increase the neuromuscular blocking activities of Aclidinium. Amantadine The therapeutic efficacy of Amantadine can be decreased when used in combination with Pyridostigmine. Amifampridine The risk or severity of adverse effects can be increased when Pyridostigmine is combined with Amifampridine. - Food Interactions
- Take with food. Food decreases irritation.
Products
Drug product information from 10+ global regionsOur datasets provide approved product information including:dosage, form, labeller, route of administration, and marketing period.Access drug product information from over 10 global regions.- Product Ingredients
Ingredient UNII CAS InChI Key Pyridostigmine bromide KVI301NA53 101-26-8 VNYBTNPBYXSMOO-UHFFFAOYSA-M Pyridostigmine chloride 45X1P9AO69 7681-22-3 TYXYRYORUZYJDX-UHFFFAOYSA-M - Product Images
- International/Other Brands
- Amiasten (AC Farma) / Amygra (Tabros) / Antilon (Yuan Chou) / Astinon (Samarth) / Kalymin (Arzneimittelwerk Dresden) / Kalymin forte (Temmler) / Kalymin N (Temmler) / Kalymin retard (Temmler) / Meshanon60 (Hasan) / Mestinon retard (Meda) / Myestin (VHB) / Pyrimine (Sriprasit Dispensary)
- Brand Name Prescription Products
Name Dosage Strength Route Labeller Marketing Start Marketing End Region Image Mestinon Tablet 60 mg Oral Bausch Health, Canada Inc. 1990-12-31 Not applicable Canada 
Mestinon Solution 60 mg/5mL Oral Bausch Health US, LLC 1965-01-25 Not applicable US 
Mestinon Tablet, extended release 180 mg/1 Oral Bausch Health US, LLC 1959-01-12 Not applicable US Mestinon Tablet 60 mg/1 Oral Bausch Health US, LLC 1955-04-06 Not applicable US Mestinon-SR Tablet, extended release 180 mg Oral Bausch Health, Canada Inc. 1991-12-31 Not applicable Canada - Generic Prescription Products
Name Dosage Strength Route Labeller Marketing Start Marketing End Region Image Jamp Pyridostigmine Bromide Tablet 60 mg Oral Jamp Pharma Corporation 2023-03-07 Not applicable Canada Pryidostigmine Bromide Solution 60 mg/5mL Oral Trigen Laboratories LLC 2020-01-30 2021-01-31 US Pryidostigmine Bromide Solution 60 mg/5mL Oral Rising Pharma Holdings, Inc. 2022-09-15 Not applicable US Pryidostigmine Bromide Solution 60 mg/5mL Oral Apnar Pharma Lp 2022-01-20 Not applicable US Pryidostigmine Bromide Solution 60 mg/5mL Oral Athem LLC 2021-02-25 Not applicable US
Categories
- ATC Codes
- N07AA02 — Pyridostigmine
- Drug Categories
- Cholinergic Agents
- Cholinesterase Inhibitors
- Cholinesterase substrates
- Cytochrome P-450 CYP3A Inducers
- Cytochrome P-450 CYP3A4 Inducers
- Cytochrome P-450 CYP3A4 Inducers (weak)
- Cytochrome P-450 Enzyme Inducers
- Enzyme Inhibitors
- Nervous System
- Neurotransmitter Agents
- Parasympathomemetic (Cholinergic) Agents
- Parasympathomimetics
- Pyridines
- Pyridinium Compounds
- Chemical TaxonomyProvided by Classyfire
- Description
- This compound belongs to the class of organic compounds known as n-methylpyridinium compounds. These are methylpyridines that carry a methyl group at the 1-position.
- Kingdom
- Organic compounds
- Super Class
- Organoheterocyclic compounds
- Class
- Pyridines and derivatives
- Sub Class
- Methylpyridines
- Direct Parent
- N-methylpyridinium compounds
- Alternative Parents
- Pyridinium derivatives / Heteroaromatic compounds / Carbamate esters / Organic carbonic acids and derivatives / Azacyclic compounds / Organopnictogen compounds / Organonitrogen compounds / Organic oxides / Hydrocarbon derivatives / Carbonyl compounds show 1 more
- Substituents
- Aromatic heteromonocyclic compound / Azacycle / Carbamic acid ester / Carbonic acid derivative / Carbonyl group / Heteroaromatic compound / Hydrocarbon derivative / N-methylpyridinium / Organic cation / Organic nitrogen compound show 6 more
- Molecular Framework
- Aromatic heteromonocyclic compounds
- External Descriptors
- pyridinium ion (CHEBI:8665)
- Affected organisms
- Humans and other mammals
Chemical Identifiers
- UNII
- 19QM69HH21
- CAS number
- 155-97-5
- InChI Key
- RVOLLAQWKVFTGE-UHFFFAOYSA-N
- InChI
- InChI=1S/C9H13N2O2/c1-10(2)9(12)13-8-5-4-6-11(3)7-8/h4-7H,1-3H3/q+1
- IUPAC Name
- 3-[(dimethylcarbamoyl)oxy]-1-methylpyridin-1-ium
- SMILES
- CN(C)C(=O)OC1=C[N+](C)=CC=C1
References
- Synthesis Reference
Gennaro, A.R., ed. (1990) Remington's Pharmaceutical Sciences, 18th ed., Easton, PA, Mack Publishing Co., p. 898.
US20040063957- General References
- Singer W, Opfer-Gehrking TL, McPhee BR, Hilz MJ, Bharucha AE, Low PA: Acetylcholinesterase inhibition: a novel approach in the treatment of neurogenic orthostatic hypotension. J Neurol Neurosurg Psychiatry. 2003 Sep;74(9):1294-8. [Article]
- Gilhus NE, Verschuuren JJ: Myasthenia gravis: subgroup classification and therapeutic strategies. Lancet Neurol. 2015 Oct;14(10):1023-36. doi: 10.1016/S1474-4422(15)00145-3. [Article]
- Rodriguez Cruz PM, Palace J, Beeson D: The Neuromuscular Junction and Wide Heterogeneity of Congenital Myasthenic Syndromes. Int J Mol Sci. 2018 Jun 5;19(6). pii: ijms19061677. doi: 10.3390/ijms19061677. [Article]
- Lee M, Beeson D, Palace J: Therapeutic strategies for congenital myasthenic syndromes. Ann N Y Acad Sci. 2018 Jan;1412(1):129-136. doi: 10.1111/nyas.13538. [Article]
- Aquilonius SM, Hartvig P: Clinical pharmacokinetics of cholinesterase inhibitors. Clin Pharmacokinet. 1986 May-Jun;11(3):236-49. doi: 10.2165/00003088-198611030-00005. [Article]
- Aquilonius SM, Eckernas SA, Hartvig P, Lindstrom B, Osterman PO: Pharmacokinetics and oral bioavailability of pyridostigmine in man. Eur J Clin Pharmacol. 1980 Nov;18(5):423-8. doi: 10.1007/BF00636797. [Article]
- Kornfeld P, Samuels AJ, Wolf RL, Osserman KE: Metabolism of 14C-labeled pyridostigmine in myasthenia gravis. Evidence for multiple metabolites. Neurology. 1970 Jul;20(7):634-41. doi: 10.1212/wnl.20.7.634. [Article]
- Somani SM, Roberts JB, Wilson A: Pyridostigmine metabolism in man. Clin Pharmacol Ther. 1972 May-Jun;13(3):393-9. doi: 10.1002/cpt1972133393. [Article]
- Katz NK, Barohn RJ: The history of acetylcholinesterase inhibitors in the treatment of myasthenia gravis. Neuropharmacology. 2021 Jan;182:108303. doi: 10.1016/j.neuropharm.2020.108303. Epub 2020 Sep 9. [Article]
- FDA Approved Drug Products: Mestinon (pyridostigmine bromide) syrup and tablets [Link]
- FDA Approved Drug Products: REGONOL (pyridostigmine bromide) injection [Link]
- NIH: pyridostigmine bromide CSWG report [Link]
- Cayman Chemical: pyridostigmine MSDS [Link]
- External Links
- Human Metabolome Database
- HMDB0014685
- KEGG Drug
- D00487
- KEGG Compound
- C07410
- PubChem Compound
- 4991
- PubChem Substance
- 46506129
- ChemSpider
- 4817
- BindingDB
- 50313079
- 9000
- ChEBI
- 8665
- ChEMBL
- CHEMBL1115
- ZINC
- ZINC000000002009
- Therapeutic Targets Database
- DNC001171
- PharmGKB
- PA451185
- RxList
- RxList Drug Page
- Drugs.com
- Drugs.com Drug Page
- Wikipedia
- Pyridostigmine
- FDA label
- Download (120 KB)
- MSDS
- Download (74.6 KB)
Clinical Trials
- Clinical Trials Learn More" title="About Clinical Trials" id="clinical-trials-info" class="drug-info-popup" href="javascript:void(0);">
Phase Status Purpose Conditions Count 4 Completed Treatment Neurogenic Orthostatic Hypotension (nOH) 1 4 Completed Treatment Postdural Puncture Headache 1 4 Completed Treatment Postural Orthostatic Tachycardia Syndrome (POTS) 1 4 Recruiting Treatment Dysphonia / Laryngeal Dystonia / Spasmodic Dysphonia 1 4 Unknown Status Supportive Care Muscle Relaxation 1
Pharmacoeconomics
- Manufacturers
- Valeant pharmaceuticals international
- Sandoz canada inc
- Barr laboratories inc
- Corepharma llc
- Impax laboratories inc
- Solvay pharmaceuticals
- United states army office surgeon general
- Packagers
- Barr Pharmaceuticals
- Corepharma LLC
- DSM Corp.
- Global Pharmaceuticals
- Heartland Repack Services LLC
- Impax Laboratories Inc.
- Kaiser Foundation Hospital
- Legacy Pharmaceuticals Packaging LLC
- Murfreesboro Pharmaceutical Nursing Supply
- Oceanside Pharmaceuticals Incorporated
- Professional Co.
- Sandoz
- Southcoast Pharmaceuticals Inc.
- Valeant Ltd.
- Dosage Forms
Form Route Strength Tablet Oral 60.00 mg Tablet, coated Oral 500 mg Tablet, coated Oral 50000000 mg Tablet Oral 60 mg Tablet, sugar coated Oral Tablet, sugar coated Oral 10 mg Tablet Oral 10 mg Tablet, sugar coated Oral 60 mg Tablet Oral 180.000 mg Tablet, extended release Oral 180 mg Tablet, extended release Oral Solution Oral 60 mg/5mL Tablet Oral 180 mg/1 Tablet Oral 30 mg/1 Tablet Oral 60 mg/1 Tablet, extended release Oral 180 mg/1 Tablet Oral Injection, solution Intravenous; Parenteral 5 mg/1mL Liquid Intramuscular; Intravenous 5 mg / mL Tablet Oral 60.000 mg Solution Oral Solution Oral 12 MG/ML Tablet, coated Oral 60 mg - Prices
Unit description Cost Unit Mestinon 30 180 mg Controlled Release Tabs Bottle 129.42USD bottle Pyridostigmine bromide powder 87.6USD g Regonol 5 mg/ml ampul 13.64USD ml Mestinon 180 mg timespan 3.59USD each Mestinon 60 mg tablet 2.46USD tablet Mestinon-Sr 180 mg Sustained-Release Tablet 1.06USD tablet Pyridostigmine Bromide 60 mg tablet 0.62USD tablet Pyridostigmine br 60 mg tablet 0.6USD tablet Mestinon 60 mg Tablet 0.48USD tablet Mestinon 60 mg/5ml Syrup 0.43USD ml DrugBank does not sell nor buy drugs. Pricing information is supplied for informational purposes only.- Patents
- Not Available
Properties
- State
- Solid
- Experimental Properties
Property Value Source melting point (°C) 152-154 https://ntp.niehs.nih.gov/ntp/htdocs/chem_background/exsumpdf/pyridostbromide_508.pdf water solubility 100 mg/ml MSDS - Predicted Properties
Property Value Source Water Solubility 1.04 mg/mL ALOGPS logP -3.1 ALOGPS logP -3.5 Chemaxon logS -2.3 ALOGPS Physiological Charge 1 Chemaxon Hydrogen Acceptor Count 1 Chemaxon Hydrogen Donor Count 0 Chemaxon Polar Surface Area 33.42 Å2 Chemaxon Rotatable Bond Count 2 Chemaxon Refractivity 49.66 m3·mol-1 Chemaxon Polarizability 19.44 Å3 Chemaxon Number of Rings 1 Chemaxon Bioavailability 1 Chemaxon Rule of Five Yes Chemaxon Ghose Filter No Chemaxon Veber's Rule Yes Chemaxon MDDR-like Rule No Chemaxon - Predicted ADMET Features
Property Value Probability Human Intestinal Absorption + 0.9441 Blood Brain Barrier + 0.9818 Caco-2 permeable + 0.6465 P-glycoprotein substrate Non-substrate 0.737 P-glycoprotein inhibitor I Non-inhibitor 0.915 P-glycoprotein inhibitor II Non-inhibitor 0.8654 Renal organic cation transporter Non-inhibitor 0.8863 CYP450 2C9 substrate Non-substrate 0.7541 CYP450 2D6 substrate Non-substrate 0.7082 CYP450 3A4 substrate Substrate 0.586 CYP450 1A2 substrate Non-inhibitor 0.9045 CYP450 2C9 inhibitor Non-inhibitor 0.9341 CYP450 2D6 inhibitor Non-inhibitor 0.9274 CYP450 2C19 inhibitor Non-inhibitor 0.9025 CYP450 3A4 inhibitor Non-inhibitor 0.9782 CYP450 inhibitory promiscuity Low CYP Inhibitory Promiscuity 0.8422 Ames test Non AMES toxic 0.9133 Carcinogenicity Non-carcinogens 0.9193 Biodegradation Ready biodegradable 0.5528 Rat acute toxicity 3.1468 LD50, mol/kg Not applicable hERG inhibition (predictor I) Weak inhibitor 0.9248 hERG inhibition (predictor II) Non-inhibitor 0.8484
Spectra
- Mass Spec (NIST)
- Not Available
- Spectra
Spectrum Spectrum Type Splash Key Predicted GC-MS Spectrum - GC-MS Predicted GC-MS splash10-0006-9700000000-144f11d8d4fca931e26f Predicted 1H NMR Spectrum 1D NMR Not Applicable Predicted 13C NMR Spectrum 1D NMR Not Applicable - Chromatographic Properties
Collision Cross Sections (CCS)
Adduct CCS Value (Å2) Source type Source [M-H]- 148.4403833 predictedDarkChem Lite v0.1.0 [M-H]- 148.1016833 predictedDarkChem Lite v0.1.0 [M-H]- 131.35751 predictedDeepCCS 1.0 (2019) [M-H]- 148.4403833 predictedDarkChem Lite v0.1.0 [M-H]- 148.1016833 predictedDarkChem Lite v0.1.0 [M-H]- 131.35751 predictedDeepCCS 1.0 (2019) [M+H]+ 149.2595833 predictedDarkChem Lite v0.1.0 [M+H]+ 149.0467833 predictedDarkChem Lite v0.1.0 [M+H]+ 133.7541 predictedDeepCCS 1.0 (2019) [M+H]+ 149.2595833 predictedDarkChem Lite v0.1.0 [M+H]+ 149.0467833 predictedDarkChem Lite v0.1.0 [M+H]+ 133.7541 predictedDeepCCS 1.0 (2019) [M+Na]+ 148.8603833 predictedDarkChem Lite v0.1.0 [M+Na]+ 148.5700833 predictedDarkChem Lite v0.1.0 [M+Na]+ 139.8665 predictedDeepCCS 1.0 (2019) [M+Na]+ 148.8603833 predictedDarkChem Lite v0.1.0 [M+Na]+ 148.5700833 predictedDarkChem Lite v0.1.0 [M+Na]+ 139.8665 predictedDeepCCS 1.0 (2019)
Targets
- Kind
- Protein
- Organism
- Humans
- Pharmacological action
- Yes
- Actions
- Inhibitor
- General Function
- Identical protein binding
- Specific Function
- Esterase with broad substrate specificity. Contributes to the inactivation of the neurotransmitter acetylcholine. Can degrade neurotoxic organophosphate esters.
- Gene Name
- BCHE
- Uniprot ID
- P06276
- Uniprot Name
- Cholinesterase
- Molecular Weight
- 68417.575 Da
References
- Somani SM, Husain K, Asha T, Helfert R: Interactive and delayed effects of pyridostigmine and physical stress on biochemical and histological changes in peripheral tissues of mice. J Appl Toxicol. 2000 Jul-Aug;20(4):327-34. [Article]
- Servatius RJ, Ottenweller JE, Guo W, Beldowicz D, Zhu G, Natelson BH: Effects of inescapable stress and treatment with pyridostigmine bromide on plasma butyrylcholinesterase and the acoustic startle response in rats. Physiol Behav. 2000 May;69(3):239-46. [Article]
- Abou-Donia MB, Wilmarth KR, Abdel-Rahman AA, Jensen KF, Oehme FW, Kurt TL: Increased neurotoxicity following concurrent exposure to pyridostigmine bromide, DEET, and chlorpyrifos. Fundam Appl Toxicol. 1996 Dec;34(2):201-22. [Article]
- FDA Approved Drug Products: Mestinon (pyridostigmine bromide) syrup and tablets [Link]
- FDA Approved Drug Products: REGONOL (pyridostigmine bromide) injection [Link]
- Kind
- Protein
- Organism
- Humans
- Pharmacological action
- Yes
- Actions
- Inhibitor
- General Function
- Serine hydrolase activity
- Specific Function
- Terminates signal transduction at the neuromuscular junction by rapid hydrolysis of the acetylcholine released into the synaptic cleft. Role in neuronal apoptosis.
- Gene Name
- ACHE
- Uniprot ID
- P22303
- Uniprot Name
- Acetylcholinesterase
- Molecular Weight
- 67795.525 Da
References
- Drake-Baumann R, Seil FJ: Effects of exposure to low-dose pyridostigmine on neuromuscular junctions in vitro. Muscle Nerve. 1999 Jun;22(6):696-703. [Article]
- Ricordel I, Meunier J: [Chemical weapons: antidotes. View about the real means, perspectives]. Ann Pharm Fr. 2000 Jan;58(1):5-12. [Article]
- Prasad V, Scotch R, Chaudhuri AR, Walss C, Fathy DB, Miller C, Luduena RF: Interactions of bovine brain tubulin with pyridostigmine bromide and N,N'-diethyl-m-toluamide. Neurochem Res. 2000 Jan;25(1):19-25. [Article]
- Sinton CM, Fitch TE, Petty F, Haley RW: Stressful manipulations that elevate corticosterone reduce blood-brain barrier permeability to pyridostigmine in the Rat. Toxicol Appl Pharmacol. 2000 May 15;165(1):99-105. [Article]
- Servatius RJ, Ottenweller JE, Guo W, Beldowicz D, Zhu G, Natelson BH: Effects of inescapable stress and treatment with pyridostigmine bromide on plasma butyrylcholinesterase and the acoustic startle response in rats. Physiol Behav. 2000 May;69(3):239-46. [Article]
- Chen X, Ji ZL, Chen YZ: TTD: Therapeutic Target Database. Nucleic Acids Res. 2002 Jan 1;30(1):412-5. [Article]
- FDA Approved Drug Products: Mestinon (pyridostigmine bromide) syrup and tablets [Link]
- FDA Approved Drug Products: REGONOL (pyridostigmine bromide) injection [Link]
Enzymes
- Kind
- Protein
- Organism
- Humans
- Pharmacological action
- No
- Actions
- Substrate
- General Function
- Serine hydrolase activity
- Specific Function
- Terminates signal transduction at the neuromuscular junction by rapid hydrolysis of the acetylcholine released into the synaptic cleft. Role in neuronal apoptosis.
- Gene Name
- ACHE
- Uniprot ID
- P22303
- Uniprot Name
- Acetylcholinesterase
- Molecular Weight
- 67795.525 Da
References
- Kind
- Protein
- Organism
- Humans
- Pharmacological action
- No
- Actions
- Substrate
- General Function
- Identical protein binding
- Specific Function
- Esterase with broad substrate specificity. Contributes to the inactivation of the neurotransmitter acetylcholine. Can degrade neurotoxic organophosphate esters.
- Gene Name
- BCHE
- Uniprot ID
- P06276
- Uniprot Name
- Cholinesterase
- Molecular Weight
- 68417.575 Da
References
- Kind
- Protein
- Organism
- Humans
- Pharmacological action
- No
- Actions
- Inducer
- Curator comments
- A single study has suggested weak induction of CYP3A4 by pyridostigmine bromide.
- General Function
- Vitamin d3 25-hydroxylase activity
- Specific Function
- Cytochromes P450 are a group of heme-thiolate monooxygenases. In liver microsomes, this enzyme is involved in an NADPH-dependent electron transport pathway. It performs a variety of oxidation react...
- Gene Name
- CYP3A4
- Uniprot ID
- P08684
- Uniprot Name
- Cytochrome P450 3A4
- Molecular Weight
- 57342.67 Da
References
- Usmani KA, Rose RL, Hodgson E: Inhibition and activation of the human liver microsomal and human cytochrome P450 3A4 metabolism of testosterone by deployment-related chemicals. Drug Metab Dispos. 2003 Apr;31(4):384-91. doi: 10.1124/dmd.31.4.384. [Article]
Drug created at June 13, 2005 13:24 / Updated at February 20, 2024 23:54