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Medical and Pharmacy Editor:

Brand Name: Mestinon, Regonol

Generic Name: Pyridostigmine

Drug Class: Acetylcholinesterase Inhibitors, Peripheral

What Is Pyridostigmine and How Does It Work?

Pyridostigmine is a cholinesterase inhibitor used to treat the symptoms of myasthenia gravis. Mestinon is also used in military personnel who have been exposed to nerve gas.

Pyridostigmine is available under the following different brand names: Mestinon and Regonol.

Dosages of Pyridostigmine:

Dosage Forms and Strengths

Injection solution

  • 5 mg/mL

Tablet, controlled release

  • 180 mg


  • 60 mg


  • 60mg/5mL (240mL)

Dosage Considerations – Should be Given as Follows:

Myasthenia Gravis

  • Adults: Tablets/syrup: 600 mg/day spaced to provide maximum relief
  • Adults: Sustained release: 180-540 mg orally once/day or every 12 hours; not to exceed 1.5 g/day
  • Children
    • 7 mg/kg/day orally divided every 4 hours
    • 0.05-0.15 mg/kg intravenously/intramuscularly (IV/IM) every 4-6 hours; not to exceed 10 mg/dose
  • Neonates
    • 5 mg orally every 4-6 hours
    • 0.05-0.15 mg/kg IV/IM every 4-6 hours; not to exceed 10 mg/dose

Reversal of Nondepolarizing Muscle Relaxants


  • 0.1-0.25 mg/kg/dose
  • 10-20 mg generally effective; full recovery may occur as early as less than 15 minutes but may require greater than 30 minutes
  • To minimize side effects 0.6-1.2 mg intravenously (IV) atropine sulfate recommended immediately prior to pyridostigmine


  • 0.1-0.25 mg/kg/dose intravenously (IV)
  • Dosing range: 0.1-0.25 mg/kg/dose; full recovery may occur as early as less than 15 minutes but may require greater than 30 minutes

Pretreatment for Soman Nerve Gas Exposure

  • 30 mg orally every 8 hours beginning several hours prior to exposure
  • Discontinue at first sign of nerve agent exposure then begin atropine and pralidoxime
Medically Reviewed by a Doctor on 9/6/2017

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