Details of Drug

Drug General Information (ID: D1365)
Drug Name	Pyridostigmine
Drug Type	Small molecule
Drug Synonymous	Pyridostigminum; Pyridostigmine Bromine; Mestinon (TN); Mestinon-SR; Regonol (TN); AQ-776/42801589; Pyridinium, 3-hydroxy-1-methyl-, dimethylcarbamate (ester); Pyridinium, 3-(((dimethylamino)carbonyl)oxy)-1-methyl-(9CI); (1-methylpyridin-1-ium-3-yl) N,N-dimethylcarbamate; 1-methyl-3-pyridiniumyl dimethylcarbamate; 3-(((Dimethylamino)carbonyl)oxy)-1-methylpyridinium Click to Show/Hide
Disease Class	8C6Y: Myasthenia gravis
Therapeutic Class	Parasympathomimetics
Structure
Structure	3D Structure		2D Structure
Formula	C9H13N2O2+
InChI	1S/C9H13N2O2/c1-10(2)9(12)13-8-5-4-6-11(3)7-8/h4-7H,1-3H3/q+1
InChIKey	RVOLLAQWKVFTGE-UHFFFAOYSA-N
Canonical SMILES	C[N+]1=CC=CC(=C1)OC(=O)N(C)C
External Link
	Pubchem ID	4991
	CAS Number	155-97-5
	CHEBI ID	8665
	TTD ID	D0O2WB

Drug-Drug Interaction Network
Sunburst Graph		Legend Information AM006 Pharmacodynamic additive effects AM007 Pharmacodynamic antagonistic effects BM037 Additive cholinergic effects BM045 Additive neuromuscular blocking effects BM049 Increased risk of atrioventricular block BM051 Increased risk of bradycardia BM081 Increased risk of ventricular arrhythmias BM091 Antagonize the effect of cholinergic agents
Relation Graph

Full list of drugs interacting with Pyridostigmine
Pharmacodynamic additive effects
	Additive cholinergic effects					Drug Num: 6
Drug ID		Drug Name	Formula	Pubchem ID	Severity Level		Interaction Detail	REF
D0175		Bethanechol	C7H17N2O2+	2370	Moderate		Inter Info	[26], [27], [28]
D0516		Donepezil	C24H29NO3	3152	Moderate		Inter Info	[26], [27], [28]
D0552		Edrophonium	C10H16NO+	3202	Moderate		Inter Info	[26], [27], [28]
D1122		Neostigmine	C12H19N2O2+	4456	Moderate		Inter Info	[26], [27], [28]
D1418		Rivastigmine	C14H22N2O2	77991	Moderate		Inter Info	[26], [27], [28]
D1525		Tacrine	C13H14N2	1935	Moderate		Inter Info	[26], [27], [28]
	Additive neuromuscular blocking effects					Drug Num: 8
Drug ID		Drug Name	Formula	Pubchem ID	Severity Level		Interaction Detail	REF
D0056		Amikacin	C22H43N5O13	37768	Moderate		Inter Info	[1], [2], [3], [4], [5], [6], [7], [8], [9], [10], [11], [12], [13], [14], [15], [16], [17], [18], [19]
D0718		Gentamicin	C21H43N5O7	3467	Moderate		Inter Info	[1], [2], [3], [4], [5], [6], [7], [8], [9], [10], [11], [12], [13], [14], [15], [16], [17], [18], [19]
D0876		Kanamycin	C18H36N4O11	6032	Moderate		Inter Info	[1], [2], [3], [4], [5], [6], [7], [8], [9], [10], [11], [12], [13], [14], [15], [16], [17], [18], [19]
D1120		Neomycin	C23H46N6O13	8378	Moderate		Inter Info	[1], [2], [3], [4], [5], [6], [7], [8], [9], [10], [11], [12], [13], [14], [15], [16], [17], [18], [19]
D1126		Netilmicin	C21H41N5O7	441306	Moderate		Inter Info	[1], [2], [3], [4], [5], [6], [7], [8], [9], [10], [11], [12], [13], [14], [15], [16], [17], [18], [19]
D1228		Paromomycin	C23H45N5O14	165580	Moderate		Inter Info	[1], [2], [3], [4], [5], [6], [7], [8], [9], [10], [11], [12], [13], [14], [15], [16], [17], [18], [19]
D1507		Streptomycin	C21H39N7O12	19649	Moderate		Inter Info	[1], [2], [3], [4], [5], [6], [7], [8], [9], [10], [11], [12], [13], [14], [15], [16], [17], [18], [19]
D1597		Tobramycin	C18H37N5O9	36294	Moderate		Inter Info	[1], [2], [3], [4], [5], [6], [7], [8], [9], [10], [11], [12], [13], [14], [15], [16], [17], [18], [19]
	Increased risk of bradycardia					Drug Num: 5
Drug ID		Drug Name	Formula	Pubchem ID	Severity Level		Interaction Detail	REF
D0031		Alectinib	C30H34N4O2	49806720	Moderate		Inter Info	[24], [25]
D0393		Crizotinib	C21H22Cl2FN5O	11626560	Moderate		Inter Info	[3], [29], [30]
D0661		Fingolimod	C19H33NO2	107970	Moderate		Inter Info	[31], [32]
D0897		Lasmiditan	C19H18F3N3O2	11610526	Moderate		Inter Info	[33]
D1211		Ozanimod	C23H24N4O3	52938427	Moderate		Inter Info	[34]
	Increased risk of ventricular arrhythmias					Drug Num: 1
Drug ID		Drug Name	Formula	Pubchem ID	Severity Level		Interaction Detail	REF
D1569		Thalidomide	C13H10N2O4	5426	Moderate		Inter Info	[2], [3], [35]
Pharmacodynamic antagonistic effects
	Antagonize the effect of cholinergic agents					Drug Num: 30
Drug ID		Drug Name	Formula	Pubchem ID	Severity Level		Interaction Detail	REF
D0160		Benzatropine	C21H25NO	1201549	Moderate		Inter Info	[20]
D0172		Betamethasone	C22H29FO5	9782	Moderate		Inter Info	[21], [22], [23]
D0370		Clozapine	C18H19ClN4	135398737	Moderate		Inter Info	[20]
D0424		Darifenacin	C28H30N2O2	444031	Moderate		Inter Info	[20]
D0508		Disopyramide	C21H29N3O	3114	Moderate		Inter Info	[20]
D0782		Hyoscyamine	C17H23NO3	154417	Moderate		Inter Info	[20]
D1347		Procyclidine	C19H29NO	4919	Moderate		Inter Info	[20]
D0183		Biperiden	C21H29NO	2381	Moderate		Inter Info	[20]
D0215		Budesonide	C25H34O6	5281004	Moderate		Inter Info	[21], [22], [23]
D0353		Clidinium	C22H26NO3+	2784	Moderate		Inter Info	[20]
D0392		Corticotropin	C207H308N56O58S	16132265	Moderate		Inter Info	[21], [22], [23]
D0436		Deflazacort	C25H31NO6	189821	Moderate		Inter Info	[21], [22], [23]
D0662		Flavoxate	C24H25NO4	3354	Moderate		Inter Info	[20]
D0671		Fludrocortisone	C21H29FO5	31378	Moderate		Inter Info	[21], [22], [23]
D0759		Homatropine	C16H21NO3	5282593	Moderate		Inter Info	[20]
D0773		Hydrocortisone	C21H30O5	5754	Moderate		Inter Info	[21], [22], [23]
D1000		Mepenzolate	C21H26NO3+	4057	Moderate		Inter Info	[20]
D1202		Oxybutynin	C22H31NO3	4634	Moderate		Inter Info	[20]
D1332		Prednisolone	C21H28O5	5755	Moderate		Inter Info	[21], [22], [23]
D1334		Prednisone	C21H26O5	5865	Moderate		Inter Info	[21], [22], [23]
D1343		Procainamide	C13H21N3O	4913	Moderate		Inter Info	[20]
D1371		Quinidine	C20H24N2O2	441074	Moderate		Inter Info	[20]
D1450		Scopolamine	C17H21NO4	3000322	Moderate		Inter Info	[20]
D1491		Solifenacin	C23H26N2O2	154059	Moderate		Inter Info	[20]
D1563		Tetracosactide	C136H210N40O31S	16133802	Moderate		Inter Info	[21], [22], [23]
D1607		Tolterodine	C22H31NO	443879	Moderate		Inter Info	[20]
D1628		Triamcinolone	C21H27FO6	31307	Moderate		Inter Info	[21], [22], [23]
D1630		Triamcinolone (ophthalmic)	C21H27FO6	31307	Moderate		Inter Info	[21], [22], [23]
D1641		Trihexyphenidyl	C20H31NO	5572	Moderate		Inter Info	[20]
D1656		Trospium	C25H30NO3+	5284632	Moderate		Inter Info	[20]

References
1	Burkett L, Bikhazi GB, Thomas KC Jr, Rosenthal DA, Wirta MG, Foldes FF "Mutual potentiation of the neuromuscular effects of antibiotics and relaxants." Anesth Analg 58 (1979): 107-15. [PMID: 571233]
2	Cerner Multum, Inc. "Australian Product Information.".
3	Cerner Multum, Inc. "UK Summary of Product Characteristics.".
4	Chapple DJ, Clark JL, Hughes R "Interaction between atracurium and drugs used in anaesthesia." Br J Anaesth 55 Suppl (1983): s17-22. [PMID: 6688011]
5	Dupuis JY, Martin R, Tetrault JP "Atracurium and vecuronium interaction with gentamicin and tobramycin." Can J Anaesth 36 (1989): 407-11. [PMID: 2569365]
6	Geha DG, Blitt CD, Moon BJ "Prolonged neuromuscular blockade with pancuronium in the presence of acute renal failure: a case report." Anesth Analg 55 (1976): 343-5. [PMID: 945014]
7	Giala M, Sareyiannis C, Cortsaris N, Paradelis A, Lappas DG "Possible interaction of pancuronium and tubocurarine with oral neomycin." Anaesthesia 37 (1982): 776. [PMID: 7103026]
8	Giala MM, Paradelis AG "Two cases of prolonged respiratory depression due to interaction of pancuronium with colistin and streptomycin." J Antimicrob Chemother 5 (1979): 234-5. [PMID: 429254]
9	Hasfurther DL, Bailey PL "Failure of neuromuscular blockade reversal after rocuronium in a patient who received oral neomycin." Can J Anaesth 43 (1996): 617-20. [PMID: 8773869]
10	Jedeikin R, Dolgunski E, Kaplan R, Hoffman S "Prolongation of neuromuscular blocking effect of vecuronium by antibiotics." Anaesthesia 42 (1987): 858-60. [PMID: 2889390]
11	Kronenfeld MA, Thomas SJ, Turndorf H "Recurrence of neuromuscular blockade after reversal of vecuronium in a patient receiving polymyxin/amikacin sternal irrigation." Anesthesiology 65 (1986): 93-4. [PMID: 2873764]
12	Levanen J, Nordman R "Complete respiratory paralysis caused by a large dose of streptomycin and its treatment with calcium chloride." Ann Clin Res 7 (1975): 47-9. [PMID: 1155911]
13	Lippmann M, Yang E, Au E, Lee C "Neuromuscular blocking effects of tobramycin, gentamicin, and cefazolin." Anesth Analg 61 (1982): 767-70. [PMID: 7201757]
14	Pittinger CB, Eryasa Y, Adamson R "Antibiotic-induced paralysis." Anesth Analg 49 (1970): 487-501. [PMID: 4102601]
15	Product Information. Arikayce (amikacin liposome). Insmed Incorporated, Bridgewater, NJ.
16	Product Information. Humatin (paromomycin). Parke-Davis, Morris Plains, NJ.
17	Regan AG, Perumbetti PP "Pancuronium and gentamicin interaction in patients with renal failure." Anesth Analg 59 (1980): 393. [PMID: 6989291]
18	Vanacker BF, Van de Walle J "The neuromuscular blocking action of vecuronium in normal patients and in patients with no renal function and interaction vecuronium- tobramycin in renal transplant patients." Acta Anaesthesiol Belg 37 (1986): 95-9. [PMID: 2875595]
19	Warner WA, Sanders E "Neuromuscular blockade associated with gentamicin therapy." JAMA 215 (1971): 1153-4. [PMID: 4250687]
20	Product Information. Mestinon (pyridostigmine). ICN Pharmaceuticals Inc, Cost Mesa, CA.
21	Brunner NG, Namba T, Grob D "Corticosteroids in management of severe, generalized myasthenia gravis." Neurology 22 (1972): 603-10
22	Namba T "Corticotropin therapy in patients with myasthenia gravis." Arch Neurol 26 (1972): 144-50
23	Patten BM, Oliver KL, Engel WK "Adverse interaction between steroid hormones and anticholinesterase drugs." Neurology 24 (1974): 442-9
24	Product Information. Kaletra (lopinavir-ritonavir) Abbott Pharmaceutical, Abbott Park, IL.
25	Product Information. Alecensa (alectinib). Genentech, South San Francisco, CA.
26	Product Information. Aricept (donepezil). Pfizer US Pharmaceuticals, New York, NY.
27	Product Information. Cognex (tacrine). Parke-Davis, Morris Plains, NJ.
28	Product Information. Reminyl (galantamine) Janssen Pharmaceuticals, Titusville, NJ.
29	Product Information. Xalkori (crizotinib). Pfizer U.S. Pharmaceuticals Group, New York, NY.
30	Canadian Pharmacists Association "e-CPS."
31	Product Information. Gilenya (fingolimod). Novartis Pharmaceuticals, East Hanover, NJ.
32	FDA. U.S. Food and Drug Administration "FDA Drug Safety Communication: Revised recommendations for cardiovascular monitoring and use of multiple sclerosis drug Gilenya (fingolimod).".
33	Product Information. Reyvow (lasmiditan). Lilly, Eli and Company, Indianapolis, IN.
34	Product Information. Zeposia (ozanimod). Celgene Corporation, Summit, NJ.
35	Product Information. Thalomid (thalidomide). Celgene Corporation, Warren, NJ.

Details of Drug

Details of Drug

Cite MecDDI

About MecDDI

Correspondence