The Basics
What is Pyridostigmine?
Can reverse the effects of certain types of anesthesia on the muscles after surgery.
Brand names for Pyridostigmine
Mestinon
How Pyridostigmine is classified
Cholinesterase Inhibitors, Parasympathomimetics
Pyridostigmine During Pregnancy
Pyridostigmine pregnancy category
Category N/ANote that the FDA has deprecated the use of pregnancy categories, so for some medications, this information isn’t available. We still think it’s useful to list historical info, however, given what a common proxy this has been in the past.
What we know about taking Pyridostigmine while pregnant
The safety of Mestinon (pyridostigmine) during pregnancy or lactation in humans has not been established. Therefore, use of Mestinon (pyridostigmine) in women who may become pregnant requires weighing the drug’s potential benefits against its possible hazards to mother and child.
Taking Pyridostigmine While Breastfeeding
What are recommendations for lactation if you're taking Pyridostigmine?
Because of the low levels of pyridostigmine in breastmilk, amounts ingested by the infant are small and infant serum levels are very low. Pyridostigmine is not be expected to cause any adverse effects in breastfed infants. Most mothers with myasthenia gravis are able to nurse successfully with pyridostigmine treatment, but occasionally breastfeeding must be discontinued to avoid excessive fatigue in the mother.
Maternal / infant drug levels
Because of the low levels of pyridostigmine in breastmilk, amounts ingested by the infant are small and infant serum levels are very low. Pyridostigmine is not be expected to cause any adverse effects in breastfed infants. Most mothers with myasthenia gravis are able to nurse successfully with pyridostigmine treatment, but occasionally breastfeeding must be discontinued to avoid excessive fatigue in the mother.
Possible effects of Pyridostigmine on milk supply
Relevant published information in nursing mothers was not found as of the revision date. In animals, cholinergic drugs increase oxytocin release,[3] and have variable effects on serum prolactin.[4] The prolactin level in a mother with established lactation may not affect her ability to breastfeed.
In a case series of 69 pregnancies in 65 women with myasthenia gravis over 27 years, 49 patients received pyridostigmine during pregnancy and lactation. Lactation data were available for 33 patients, and 25 of them nursed successfully, although the number of these mothers who were taking pyridostigmine was not given. Nursing was sometimes disrupted to avoid exhaustion in the mother.[5]
Possible alternatives to Pyridostigmine
Neostigmine.
List of References
Lactation sources: Drugs and Lactation Database (LactMed) [Internet]. Bethesda (MD): National Library of Medicine (US); 2006-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK501922/1. Skoglund RR, Roberts CC, Huddlestone J. The role of anti-acetylcholine receptor antibody in neonatal myasthenia gravis. Bull Los Angeles Neurol Soc. 1978;43:66-9. PMID: 757366
2. Hardell LI, Lindstrom B, Lonnerholm G, Olofosterman P. Pyridostigmine in human breast milk. Br J Clin Pharmacol. 1982;14:565-7. PMID: 7138742
3. Clarke G, Fall CH, Lincoln DW, Merrick LP. Effects of cholinoceptor antagonists on the suckling-induced and experimentally evoked release of oxytocin. Br J Pharmacol. 1978;63:519-27. PMID: 566601
4. Muller EE, Locatelli V, Cella S et al. Prolactin-lowering and -releasing drugs: mechanisms of action and therapeutic applications. Drugs. 1983;25:399-432. PMID: 6133737
5. Djelmis J, Sostarko M, Mayer D, Ivanisevic M. Myasthenia gravis in pregnancy: report on 69 cases. Eur J Obstet Gynecol Reprod Biol. 2002;104:21-5. PMID: 12128277
Disclaimer: This material is provided for educational purposes only and is not intended for medical advice, diagnosis, or treatment. Consult your healthcare provider with any questions.
