Patient leaflet - Pyridostigmine Bromide 60 mg tablets
1. What Pyridostigmine bromide tablets is and what it is used for
Pyridostigmine bromide tablets is used for the treatment of myasthenia gravis. In patients who suffer from myasthenia gravis the muscles quickly become tired and weak and, in severe cases, the muscles may become paralysed.
Myasthenia gravis is caused by excessive activity in the body of a protein called cholinesterase.
This medicine belongs to a group of medicines known as cholinesterase inhibitors. Cholinesterase inhibitors stop the excessive activity of cholinesterase and in this way help muscles to work properly.
Pyridostigmine bromide tablets is also used to treat some rare forms of constipation (paralytic ileus) and inability to pass urine after an operation.
2. Before you take Pyridostigmine bromide tablets
Do not take Pyridostigmine bromide tablets if you:
- Are allergic (hypersensitive) to pyridostigmine, bromides or any of the other ingredients of Pyridostigmine bromide tablets (these are listed in section 6, ˝Further Information˝).
- Are constipated or cannot urinate, unless your doctor has told you to use this medicine. This is because this medicine is only for some types of constipation and inability to pass urine (see Section 1).
Warnings and precautions
Before treatment with Pyridostigmine bromide tablets, tell your doctor if you:
- Suffer from asthma or have other chest problems such as wheeziness, difficulty in breathing or chronic cough.
- Have recently had coronary obstruction (heart attack), have a slow heart beat or any other heart condition.
- Have low blood pressure. • Have a stomach ulcer.
- Have epilepsy.
- Have Parkinson’s disease.
- Have kidney problems.
- Suffer from a condition called vagotonia (this is a condition where overactivity of the vagus nerve causes symptoms such as slow heart rate, low blood pressure, constipation, sweating and painful muscle spasms).
- Have an overactive thyroid gland
- Have had an operation to remove your thymus gland.
There is no evidence to suggest that this medicine has any special effects on elderly patients.
Taking other medicines
Please tell your doctor or pharmacist if you are taking or have recently taken any other medicines, including medicines obtained without a prescription.
This is extremely important, as using more than one medicine at the same time can strengthen or weaken the effect of the medicines. In particular, tell your doctor if you are taking any of the following medicines:
- Medicines known as steroids or other immunosuppressant medicines.
- Medicines known as antimuscarinics (e.g. atropine, hyoscine).
- Medicines containing methylcellulose
- Antibiotics
- Medicines to treat an irregular heart beat
- Other medicines that interfere with transmission between nerves and muscles
If you are going to have surgery
Tell your doctor that you are taking Pyridostigmine bromide tablets. This medicine can stop the effect of some medicines used to relax muscles during surgery (e.g. pancuronium, vencuronium).
This medicine can also prolong the effect of other muscle relaxants (e.g. suxamethonium).
Pregnancy and breast-feeding
Tell your doctor before you start treatment if you:
- Are pregnant, if you think you are pregnant, or if you intend to become pregnant.
- Are breast-feeding, as Pyridostigmine bromide tablets passes into breast milk in small amounts.
Your doctor will then decide if you can take this medicine.
Driving and using machines
Pyridostigmine bromide tablets may reduce the sharpness of your eyesight and therefore your ability to drive or use machines. Do not drive or operate machines if this medicine affects your ability to see clearly.
Important information about some of the ingredients of Pyridostigmine bromide tablets
Pyridostigmine bromide tablet contains lactose. Therefore, if you have been told by your doctor that you have an intolerance to some sugars, contact your doctor before taking this medicinal product.
3. How to take Pyridostigmine bromide tablets
Swallow the tablets with water or another non-alcoholic drink. If you have difficulty swallowing, you can break the tablets into pieces.
Pyridostigmine bromide can be divided into equal doses.
You should check with your doctor or pharmacist if you are not sure how to take Pyridostigmine bromide tablets.
The dose will depend on your illness, your needs and on your age as follows:
For myasthenia gravis:
- The usual adult dose is ½ to 2 tablets (30 to 120 mg Pyridostigmine bromide tablets) to be taken five to six times daily, or higher doses if needed, as recommended by your doctor.
For children under 6 years, the usual dose is ½ a tablet (30 mg). For children aged 6 to 12 years, the usual starting dose is 1 tablet (60 mg). The doctor will then gradually increase the dose until maximum improvement is seen. In children the total dose per day is usually 30 to 360 mg.
The tablets take 30 to 60 minutes to start working after you have taken them.
The effect of each dose should last about four hours during the day and about six hours at night.
You should try to take your medicine so that it can work when your muscles are needed most, for example, when you get up and about 30 to 60 minutes before a meal.
For paralytic ileus (constipation) and post-operative inability to pass urine:
- The usual adult dose is 1 to 4 tablets (60 to 240 mg) daily and for children ¼ to 1 tablet (15 to 60 mg) daily, depending on the needs of the patient.
If you take more Pyridostigmine bromide tablets than you should
If you take too many tablets or someone else accidentally takes your medicine, contact your doctor, pharmacist or nearest hospital straight away.
If you forget to take Pyridostigmine bromide tablets
If you forget to take one of your daily doses, take it as soon as you remember, and take the next dose at the normal time. Do not take a double dose to make up for a forgotten dose. If you miss more than a single dose, you should contact your doctor for advice.
4. Possible side effects
Like all medicines, this medicine can cause side effects, although not everybody gets them.
Possible side effects with this medicine:
Side effects of unknown frequency:
- Sensitivity to drug
- Temporary loss of consciouness
- Hypotension, Flushing
- Blurred vision
- visual disturbance, producing more tears than usual an irregular heartbeat, heart block, low blood pressure, fainting
- producing more phlegm than usual combined with constriction of the airways
- feeling sick, vomiting, diarrhoea, stomach discomfort pain and cramps, producing more saliva than usual
- rash
- excessive sweating
- muscle weakness and twitching, shaking, muscle cramps
- sudden, compelling urge to urinate
Reporting of side effects
If you get any side effects, talk to your doctor, pharmacist or nurse. This includes any possible side effects not listed in this leaflet.
You can also report side effects directly via the Yellow Card Scheme at: www.mhra.gov.uk/yellowcard
By reporting side effects you can help provide more information on the safety of this medicine.
5. How to store Pyridostigmine bromide tablets
Keep this medicine out of the sight and reach of children.
Do not use this medicine after the expiry date which is stated on the carton and bottle label. The expiry date refers to the last day of that month.
Store in the original package in order to protect from light and moisture.
Keep the bottle tightly closed in order to protect from moisture.
Do not use longer than 3 months after first opening.
Do not throw away any medicines via wastewater or household waste. Ask your pharmacist how to throw away medicines you no longer use. These measures will help protect the environment.
6. Further information
What Pyridostigmine bromide tablets contains
The active substance is pyridostigmine bromide.
Each tablet contains 60 mg pyridostigmine bromide.
The other ingredients are lactose monohydrate, cellulose, microcrystalline, sodium citrate, citric acid, magnesium stearate and colloidal anhydrous silica.
What Pyridostigmine bromide tablets looks like and contents of the pack
Pyridostigmine bromide 60 mg tablets are white, 10 mm diameter round, biconvex tablets with a score line on one side.
The tablet can be divided into equal dose.
The tablets come in packs of 200 in amber glass bottles with low density polyethylene caps and desiccant.
Marketing Authorisation Holder
Neuraxpharm UK Limited
First Floor, Building 1410, Arlington Business Park,
Theale, Reading,
Berkshire RG7 4SA,
United Kingdom
Manufacturer
Neuraxpharm Arzneimittel GmbH
Elisabeth-Selbert-Straße 23
40764 Langenfeld
Germany
This leaflet was last revised in July 2026.