药品英文名
Pyridostigmine Bromide
 
药品别名
吡斯的明、吡啶斯的明、溴化吡啶斯的明、美斯的侬、美定隆、溴吡啶斯的明、Bromurede、Mestinon、Regonol、Pyridostigmine bromide
 
药物剂型
1.片剂：60mg；
2.注射剂(粉)：1mg，5mg，10mg；
3.糖浆剂：12mg(1ml)；
4.缓释片：180mg。
 
药理作用
本品为季铵化合物。作用类似新斯的明。作用开始较迟，而持续时间较长。
 
药动学
本品难从胃肠道吸收。既被胆碱酯酶水解，也在肝内代谢。本品主要以原药和代谢物随尿排出。本品极少进入CSF，但可透过胎盘，少量进入乳汁。
 
适应证
重症肌无力、麻痹性肠梗阻，也可用于逆转非除极肌松药产生的神经肌肉阻滞，但一般认为其效力不如新斯的明。虽然也可用于术后尿潴留，但当前常被导尿管所取代。
 
禁忌证
1.对本品过敏者、孕妇和哺乳者禁用。
2.机械性肠梗阻和尿路梗阻者禁用。
 
注意事项
1.慎用：(1)支气管哮喘患者；(2)术后肺不张或肺炎患者；(3)心律失常尤其是房室传导阻滞者。
2.药物对妊娠的影响：孕妇给药后，由于子宫肌收缩，可引起早产。FDA妊娠分类为C类。
3.药物对哺乳的影响：少量可分泌入乳汁中。常用剂量时，婴儿通过乳汁摄入的药物量极少，乳母可安全用药。
4.重症肌无力患者：重症肌无力患者用药须谨慎，过量时可造成神经肌接头的除极型阻滞，出现肌无力现象，即“胆碱能危象”。
5.注射给药限用于拮抗非除极肌松药，注射给药后应作严密观察。
6.口服用的糖浆或缓释片一般仅供重症肌无力治疗用。因缓释片的用量大，毒性反应也较多发生，小儿一般不用。
7.本药的某些不良反应(如心动过缓，唾液多和胃肠道症状等)比新斯的明轻。
8.使用本药应严格遵守医嘱用药，并按时做记录；漏服药后不可服用双倍量；重症肌无力患者用量要恰到好处，过量时可发生胆碱能危象。
9.本药过量的特征有：视物模糊、恶心、呕吐或(和)腹泻，严重时可导致低血钾、呼吸短促、呼吸困难、喘鸣或(和)胸闷、唾液和气管支气管黏液分泌增多，甚至可引起肺不张、胃痉挛性疼痛、脉搏减慢等，由于毒蕈样作用，可导致上肢、颈、肩、舌等处肌肉出现麻痹状态，言语不清、行动不便、步态不稳、神志不清、抽搐或阵挛等。本药中毒量时出现胆碱能危象，临床表现系胆碱样和毒蕈样毒性反应的混合。使用阿托品或东莨菪碱均能予以解除。
 
不良反应
1.长期口服可出现溴化物的反应，如皮疹、乏力、恶心和呕吐等，且比溴新斯的明严重。
2.可出现轻度的抗胆碱酯酶的毒性反应，如腹痛、腹泻、唾液增多、气管内黏液分泌增加、出汗、缩瞳、血压下降和心动过缓等，一般均能自行消失。
3.凡是对溴化物过敏者，对本品也过敏。
 
用法用量
1.治疗重症肌无力：每天总量为0.3～1.2g，也有专家认为日总量不应超过720mg。全日用量，应分次给予，包括夜间；如有必要，在明显乏力的时候，应给予较大部分的药量。儿童用量为每天7mg/kg，5～6次分服。每天可逐步增加剂量15～30mg，总用量为每天30～360mg。也可采用肌内注射，严重病例还可很缓慢静脉注射。不过，静脉注射有一定的危险性，应备好阿托品，以抵消严重的毒蕈碱反应。
2.新生儿肌无力：可肌内注射50～150μg/kg，或口服5～10mg，每4～6小时1次。不过，临床更愿意使用新斯的明。
3.逆转由非除极肌松药产生的神经肌肉阻滞：可静脉给予本品10～20mg，此前，先给予阿托品0.6～1.2mg，以抵消任何毒蕈碱作用。格隆溴铵可用来替代阿托品。
4.治疗麻痹性肠梗阻和术后尿潴留：可口服本品60～240mg。
 
专家点评
本品起效缓慢，作用较溴化新斯的明弱但持续时间较久，引起的心动缓慢、唾液分泌和消化道反应较轻。一般认为本品对抗非除极化型肌松药过量的效果不如新斯的明好。

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原产地英文商品名:
MESTINON 60mg/tab 100tabs/bottle
原产地英文药品名:
PYRIDOSTIGMINE BROMKIDE
中文参考商品译名:
美定隆 60毫克/片 100片/瓶
中文参考药品译名:
溴吡斯的明
生产厂家中文参考译名:
Valeant国际制药公司
生产厂家英文名:
VALEANT PHARM INTL

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Generic Name: pyridostigmine (py rid o STIG meen)

Brand Names: Mestinon, Mestinon Timespan

USES: Pyridostigmine is used to improve muscle strength in patients with a certain muscle disease (myasthenia gravis). It works by preventing the breakdown of a certain natural substance (acetylcholine) in your body. Acetylcholine is needed for normal muscle function.

HOW TO USE: Take the regular-release tablet or liquid form of this medication by mouth with or without food as directed by your doctor. If taking the liquid, use a medication-measuring spoon or device to make sure you get the correct dose. Do not use a household spoon.Take the extended-release tablet by mouth with or without food, usually 1 to 2 times daily (at least 6 hours apart) or as directed by your doctor. Do not crush or chew extended-release tablets. Doing so can release all of the drug at once, increasing the risk of side effects. Also, do not split the tablets unless they have a score line and your doctor or pharmacist tells you to do so. Swallow the whole or split tablet without crushing or chewing.Taking this medication with food or milk may help to decrease side effects.Dosage is based on your medical condition and response to therapy. Talk with your doctor about how you respond to the medication and about when you feel the most tired or weak so that your doctor can make the proper dosage changes.Do not increase your dose or take this medication more often than prescribed. Doing so may increase the risk of serious side effects.The tablet forms of this medication may become discolored due to moisture. This does not affect how well the medication works.Tell your doctor if your condition persists or worsens or if the medication stops working well.

SIDE EFFECTS: Nausea, vomiting, diarrhea, abdominal cramps, increased saliva/mucus, decreased pupil size, increased urination, or increased sweating may occur. If any of these effects persist or worsen, tell your doctor or pharmacist promptly.Remember that your doctor has prescribed this medication because he or she has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.Tell your doctor immediately if any of these unlikely but serious side effects occur: new or increased muscle cramps/weakness/twitching, shortness of breath, new or increased difficulty swallowing, slow heartbeat, dizziness, headache.A very serious allergic reaction to this drug is rare. However, seek immediate medical attention if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.In the US -Call your doctor for medical advice about side effects.

PRECAUTIONS: Before taking pyridostigmine, tell your doctor or pharmacist if you are allergic to it; or to other anticholinesterase medications (e.g., neostigmine); or to bromides; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.This medication should not be used if you have certain medical conditions. Before using this medicine, consult your doctor or pharmacist if you have: stomach/intestinal blockage, urinary blockage.Before using this medication, tell your doctor or pharmacist your medical history, especially of: lung disease (e.g., asthma, chronic obstructive pulmonary disease-COPD), kidney disease, slow/irregular heartbeat.Before having surgery, tell your doctor or dentist that you are using this medication.The liquid form of this product contains sugar and/or alcohol. Caution is advised if you have diabetes, alcohol dependence, or liver disease. Ask your doctor or pharmacist about using this product safely.Kidney function declines as you grow older. This medication is removed by the kidneys. Therefore, elderly people may be at greater risk for side effects while using this drug.During pregnancy, this medication should be used only when clearly needed. Discuss the risks and benefits with your doctor.It is not known whether this medication passes into breast milk. Consult your doctor before breast-feeding.

DRUG INTERACTIONS: Your doctor or pharmacist may already be aware of any possible drug interactions and may be monitoring you for them. Do not start, stop, or change the dosage of any medicine before checking with your doctor or pharmacist first.Before using this medication, tell your doctor or pharmacist of all prescription and nonprescription/herbal products you may use, especially of: aminoglycoside antibiotics (e.g., gentamicin), antiarrhythmic medications (e.g., quinidine), anticholinesterase eye medications (e.g., physostigmine), beta blockers (e.g., timolol, propranolol), mefloquine, narcotic pain medications (e.g., morphine, codeine).This document does not contain all possible interactions. Therefore, before using this product, tell your doctor or pharmacist of all the products you use. Keep a list of all your medications with you, and share the list with your doctor and pharmacist.

OVERDOSE: If overdose is suspected, contact your local poison control center or emergency room immediately. US residents can call the US National Poison Hotline at 1-800-222-1222. Canada residents can call a provincial poison control center. Symptoms of overdose may include: nausea, vomiting, diarrhea, greatly increased saliva/sweat/tears, blurred vision, fast/slow heartbeat, confusion, agitation, muscle cramps/weakness, inability to move, trouble breathing, loss of consciousness.

NOTES: Do not share this medication with others.

MISSED DOSE: If you miss a dose, take it as soon as you remember. If it is near the time of the next dose, skip the missed dose and resume your usual dosing schedule. Do not double the dose to catch up.

STORAGE: Store at room temperature at 59-86 degrees F (15-30 degrees C) away from light and moisture. Do not store in the bathroom. Keep all medicines away from children and pets.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company for more details about how to safely discard your product.MEDICAL ALERT: Your condition can cause complications in a medical emergency. For information about enrolling in MedicAlert, call 1-800-854-1166 (USA) or 1-800-668-1507 (Canada).