Drug General Information (ID: DDIHLN8QY4)
Drug Name			Pyridostigmine		Drug Info		Prednisone		Drug Info
Drug Type		Small molecule				Small molecule
Therapeutic Class		Parasympathomimetics				Antiinflammatory Agents
Structure

Mechanism of Pyridostigmine-Prednisone Interaction (Severity Level: Moderate)
Antagonize the effect of cholinergic agents Click to Show/Hide Mechanism Graph
Drug Name		Pyridostigmine				Prednisone
Mechanism		Acetylcholinesterase inhibitor				Reduce the therapeutic effects of acetylcholinesterase inhibitor in myasthenia gravis
Key Mechanism Factor 1
		Factor Name		Cholinergic agents
		Factor Description		The beneficial effects of cholinergic drugs may be reduced, such as reduced efficacy in the treatment of Alzheimer's disease and exacerbation of symptoms in the treatment of myasthenia gravis.
Mechanism Description		Antagonize the effect of Pyridostigmine when combined with Prednisone

Recommended Action
Management		Corticosteroid therapy should be instituted at relatively low dosages (15 to 25 mg/day of prednisone or equivalent) and in a controlled setting in patients with myasthenia gravis. Respiratory support should be available, and the dosage should be increased stepwise as tolerated (approximately 5 mg/day of prednisone or equivalent at 2- to 3-day intervals until marked clinical improvement or a dosage of 50 mg/day is reached). Dose reductions of the acetylcholinesterase inhibitor may be required as symptoms improve, which often may be delayed and gradual.

References
1	Brunner NG, Namba T, Grob D "Corticosteroids in management of severe, generalized myasthenia gravis." Neurology 22 (1972): 603-10
2	Namba T "Corticotropin therapy in patients with myasthenia gravis." Arch Neurol 26 (1972): 144-50
3	Patten BM, Oliver KL, Engel WK "Adverse interaction between steroid hormones and anticholinesterase drugs." Neurology 24 (1974): 442-9