PYRIDOSTIGMINE FOR MILITARY COMBAT MEDICAL USE (Systemic)?
? Not commercially available in Canada.
Category
- Cholinergic (anticholinesteraseinhibitor)
Description
Pyridostigmine (peer-id-oh-STIG-meen) is taken by mouth for protection against a nerve agent called soman. It shouldbe used along with wearing protective clothing including a gas mask, hoodand overgarment.
It is very important that pyridostigmine use bestopped at the first sign of nerve agent poisoning. Atropine and pralidoxime[2-PAM] are medicines that must be taken at the first sign of nerve agentpoisoning and immediately after pyridostigmine use has stopped. Atropine and2-PAM are called antidotes and help the pyridostigmine work better againstnerve agent poisoning.
Pyridostigmine is to be administered to military personnel only by or underthe immediate supervision of your chain of command or medical officer. Itis available in the following dosage form:
Before Using This Medicine
In deciding to use a medicine,the risks of taking the medicine must be weighed against the good it willdo. This is a decision you and your medical officer will make. For pyridostigmine,the following should be considered:
Allergies?Tell your doctor if you have ever had any unusualor allergic reaction to pyridostigmine or any of the anticholinesterase agents(certain drugs used during surgery like physostigmine, edrophonium, neostigmine,and ambenonium). Also tell your medical officer if you are allergic to anyother substances, such as foods, preservatives, or dyes.
Pregnancy?Pyridostigmine has not been studied in pregnantwomen. However, pyridostigmine has not been shown to cause birth defects orother major problems in animal studies.
Breast-feeding?It is not known if pyridostigmine passes intobreast milk.
Older adults?May medicines have not been studiedspecifically in older people. Therefore, it may not be known whether theywork exactly the same way they do in younger adults or if they cause differentside effects or problems in older people. There is no specific informationcomparing use of pyridostigmine in the elderly with use in other age groups.
Other medicines?Although certain medicines should not be usedtogether at all, in other cases two different medicines may be used togethereven if an interaction might occur. In these cases, your doctor may want tochange the dose, or other precautions may be necessary. Tell your health careprofessional if you are taking any other prescription or nonprescription (over-the-counter[OTC]) medicine.
Other medical problems?The presence of other medicalproblems may affect the use of pyridostigmine. Make sure you tell your medicalofficer if you have any other medical problems, especially:
- Asthma (in the bronchial tubes) or
- Irregular or slowed heartbeat or
- Slowed rate of breathing?Pyridostigmine may make the conditionworse
- Bladder blockage or
- Bowel blockage?Pyridostigmine should not be used if you havethese medical problems
- Bromide allergy?Rash and other side effects may occur
Proper Use of This Medicine
Dosing?Take this medicine exactly as directed. Do not skip, double up on your dose, or stop taking it unless directedby your medical officer. Taking pyridostigmine right before being exposedto soman nerve agent (e.g., when the gas attack alarm is given) or at thesame time as poisoning by soman may not work. And, it may make the symptomsof an exposure to soman much worse.
Pyridostigmine use must be stopped at the first signof nerve agent poisoning. Tell your medical officer or chain of commandif you think you may have symptoms of nerve agent poisoning such as weak musclesor trouble breathing.
It is important that you wear protective clothes such as masks, hoods andovergarments designed to protect against nerve agent poisoning.
The dose of pyridostigmine will be determined by your chain of commandand/or medical officer based on the threat of soman nerve agent exposure. Follow your medical officer's directions about how much andwhen to take this medicine.. The following is the dosing informationfor pyridostigmine.
- For oral dosage form (tablets):
- For protection against soman nerve agent poisoning:
- Adults?The usual dose is one 30 mg tablet every 8 hours
Missed dose?If you miss a dose of this medicine, take itas soon as possible. However, if it is almost time for your next dose, skipthe missed dose and go back to your regular dosing schedule. Do not doubledoses.
Storage?To store this medicine:
- Store in the refrigerator.
- Store away from direct light.
- Do not keep outdated medicine or medicine no longer needed. Ask yourmedical officer how you should dispose of any medicine you do not use. Besure that any discarded medicine is out of the reach of children.
Precautions While Using This Medicine
Ifyou experience serious side effects such as difficulty breathing, severe dizziness,or loss of consciousness after taking pyridostigmine, you should contact yourmedical officer immediately.
Side Effects of This Medicine
Along with its needed effects, a medicinemay cause some unwanted effects. Although not all of these side effects mayoccur, if they do occur they may need medical attention.
Check with your doctorimmediately if any of the following side effects occur:
Incidence not determined
blue lips and fingernails; chest pain; cough producing mucus or sometimes producing apink frothy sputum; difficult, fast, noisy breathing,sometimes with wheezing; inability to breath withoutassistance; increased sweating; irregular heartbeat; loss of bladder control; loss of bowel control; loss of consciousness; mood or mental changes; no blood pressure or pulse; numbness, tingling, pain,or weakness in hands or feet; pale skin; paleness of skin after fainting; seizures; stiffness of upper body and arms; stopping of heart; swelling in legsand ankles; trembling; unconsciousness; weakness after fainting; weakness and heaviness of legs
Other side effects may occur that usually donot need medical attention. These side effects may go away during treatmentas your body adjusts to the medicine. However, check with your doctor if anyof the following side effects continue or are bothersome:
Less common
Bloody nose; burning feeling; change in vision; crawling, itchingfeeling; difficulty in moving; dry skin; impaired vision; increased need to urinate; joint pain; muscle aching or cramping; muscle painsor stiffness; neck pain; numbness; passing urine more often; ?pins and needles? feeling; prickling feeling; swollen joints; tingling feeling
Incidence not determined
Anxiety; bloated, full feeling; discouragement; dizziness; dry mouth; excess air or gas in stomachor intestines; excessive muscle tone; eye pain; feeling of constant movementof self or surroundings; feeling of sluggishness; feeling sad or empty; hair loss; headache; hyperventilation; irritability; lack ofappetite; lightheadedness; loss of interest or pleasure; mental problems; muscle tension or tightness; nausea; nervousness; no bloodpressure or pulse; numbness of the tongue; passing gas; rash; restlessness; seeing things that are not there; seizures; sensation of spinning; shaking; stiffness of upper body andarms; swelling; thinningof hair; tingling of extremities; trouble concentrating; trouble sleeping; unusual dullness; vomiting; warm sensation; wheezing
Symptoms of overdose
Get emergency help immediately if any of the followingsymptoms of overdose occur
blurred vision; diarrhea; frequent urge to urinate; increasingmuscle weakness or paralysis, especially in the arms, neck, shoulders, andtongue; muscle cramps or twitching; nausea; shortness of breath; slow heartbeat; small pupils; stomach cramps or pain; sweating; tightness in chest; unusual tirednessor weakness; vomiting; watering of eyes or mouth; wheezing
Other side effectsnot listed above may also occur in some patients. If you notice any othereffects, check with your doctor.
Developed: 12/03/2003
