Mestinon (pyridostigmine) is a prescription drug that’s used to treat myasthenia gravis. This drug can interact with other medications. For example, Mestinon can interact with corticosteroids and anticholinergics.
Mestinon is used in adults to treat myasthenia gravis. The drug comes as an oral tablet, extended-release* oral tablet, and an oral liquid solution.
An interaction can occur because one substance causes another substance to have a different effect than expected. Interactions can also occur if you have certain health conditions.
Keep reading to learn about Mestinon’s possible interactions. And for more information about Mestinon, including details about its uses, see this article.
* “Extended release” means the drug is slowly released into your body over a long period of time.
Before you start taking Mestinon, tell your doctor and pharmacist about any prescription, over-the-counter, or other drugs you take. Sharing this information with them may help prevent possible interactions. (To learn whether Mestinon interacts with supplements, herbs, and vitamins, see the “Are there other interactions with Mestinon?” section below.)
If you have questions about drug interactions that may affect you, talk with your doctor or pharmacist.
The table below lists drugs that may interact with Mestinon. Keep in mind that this table does not include all drugs that may interact with Mestinon. For more information about some of these interactions, see the “Drug interactions explained” section below.
| Drug group or drug name | Drug examples | What can happen |
| corticosteroids | • dexamethasone • prednisone (Rayos) | can cause severe muscle weakness |
| anticholinergics | • atropine • oxybutynin (Oxytrol) | can make Mestinon and anticholinergics less effective |
| tricyclic antidepressants | • amitriptyline • imipramine (Tofranil) | can make Mestinon less effective |
| cholinergic drugs | • donepezil (Aricept) • galantamine | can increase the risk of side effects (such as slow heart rate) from Mestinon and cholinergic drugs |
| beta-blockers | • atenolol (Tenormin) • propranolol (Inderal LA, InnoPran XL) | can increase the risk of slow heart rate |
| digoxin (Lanoxin) | – | can increase the risk of slow heart rate |
Certain health conditions or other factors could raise your risk of harm if you take Mestinon. In such cases, your doctor may not prescribe Mestinon for you. These are known as contraindications. The list below includes contraindications of Mestinon.
If you have a blockage in your intestines. Your doctor will likely not prescribe Mestinon if you have a blockage in your intestines. This is because the drug can increase the muscle contractions in your intestines, which can be dangerous if you have a blockage.
If you have a blockage in your urinary system. Your doctor will likely not prescribe Mestinon if you have a blockage in your urinary system (bladder, ureters, or urethra). This is because the drug can make you need to urinate more often than usual, which can be dangerous if you have a blockage to the flow of urine.
If you’ve had an allergic reaction. If you’ve had an allergic reaction to Mestinon or any of its ingredients, your doctor likely won’t prescribe Mestinon. This is because taking the drug could cause another allergic reaction. You can ask your doctor about other treatments that may be better options for you.
Before you start taking Mestinon, talk with your doctor if any of the factors above apply to you. Your doctor can determine whether Mestinon is safe for you to take.
Mestinon (pyridostigmine) is not known to have an interaction with alcohol. But Mestinon and alcohol can cause some similar side effects, such as nausea and diarrhea. So you may be more likely to experience these side effects if you drink alcohol during your Mestinon treatment.
If you have questions about consuming alcohol while taking Mestinon, talk with your doctor or pharmacist.
Learn more about certain drug interactions that can occur with Mestinon.
Interaction with corticosteroids
Mestinon can interact with corticosteroids (often called steroids), which are used to treat various inflammatory conditions.
Examples of corticosteroids include:
- dexamethasone
- prednisone (Rayos)
- methylprednisolone (Medrol)
What could happen
Taking Mestinon with a corticosteroid can cause severe muscle weakness.
What you can do
Your doctor will likely avoid prescribing Mestinon with a corticosteroid. If they do prescribe these medications together, your doctor may prescribe a dosage of Mestinon or corticosteroid that’s lower than usual. You should not take a higher dose of either medication than your doctor prescribes.
If you take Mestinon and a corticosteroid together, tell your doctor right away if you have new or worsening muscle weakness.
If you have questions about taking Mestinon with a corticosteroid, talk with your doctor or pharmacist.
Interaction with anticholinergics
Mestinon can interact with anticholinergics, which are used to treat various conditions such as overactive bladder and urinary incontinence.
Examples of anticholinergic medications include:
- atropine
- oxybutynin (Oxytrol)
- dicyclomine (Bentyl)
What could happen
Mestinon works by speeding up the action of a chemical in the body called acetylcholine. Anticholinergics work by blocking the action of acetylcholine. So taking Mestinon with an anticholinergic can cancel out the actions of both drugs and make them both less effective.
What you can do
Your doctor will likely avoid prescribing Mestinon with an anticholinergic drug. If you have questions about this interaction, talk with your doctor or pharmacist.
Interaction with tricyclic antidepressants
Mestinon can interact with a group of antidepressants called tricyclic antidepressants (TCAs). These are prescribed for depression and some other conditions, such as nerve pain.
Examples of TCAs include:
- amitriptyline
- imipramine (Tofranil)
- clomipramine (Anafranil)
What could happen
Mestinon works by speeding up the action of a chemical in the body called acetylcholine. TCAs block the action of acetylcholine. So taking Mestinon with a TCA can cancel out the actions of both drugs and make them both less effective.
What you can do
If you take Mestinon with a TCA, your doctor may adjust your dosage of either medication. You should not take a higher dose of either medication than your doctor prescribes.
If you have questions about taking these drugs together, talk with your doctor or pharmacist.
Mestinon may have other interactions. They could occur with supplements, foods, vaccines, or even lab tests. See below for details. Note that the information below does not include all other possible interactions with Mestinon.
Does Mestinon interact with supplements?
Before you start taking Mestinon, talk with your doctor and pharmacist about any supplements, herbs, and vitamins you take. Sharing this information with them may help you avoid possible interactions.
If you have questions about interactions that may affect you, talk with your doctor or pharmacist.
Mestinon and herbs
There are currently no reports of Mestinon interacting with herbs. But this doesn’t mean that interactions with herbs won’t be recognized in the future.
For this reason, it’s still important to check with your doctor or pharmacist before taking any of these products while taking Mestinon.
Mestinon and vitamins
There are currently no reports of Mestinon interacting with vitamins. But this doesn’t mean that vitamin interactions won’t be recognized in the future.
For this reason, it’s still important to check with your doctor or pharmacist before taking any of these products while taking Mestinon.
Does Mestinon interact with food?
There are currently no reports of food interactions with Mestinon (which contains the active drug pyridostigmine). If you have questions about eating certain foods during your treatment with Mestinon, talk with your doctor.
Does Mestinon interact with vaccines?
There are currently no reports of Mestinon interacting with vaccines. If you have questions about getting certain vaccines during your Mestinon treatment, talk with your doctor.
Does Mestinon interact with lab tests?
There are currently no reports of Mestinon interacting with lab tests. If you have questions about having certain lab tests during your treatment with Mestinon, talk with the healthcare professional ordering the test.
Does Mestinon interact with cannabis or CBD?
There are currently no reports of Mestinon interacting with cannabis (commonly called marijuana) or cannabis products such as cannabidiol (CBD). But as with any drug or supplement, talk with your doctor before using cannabis with Mestinon.
Note: Cannabis is illegal at a federal level but is legal in many states to varying degrees.
Certain medical conditions or other health factors may raise the risk of interactions with Mestinon. Before taking Mestinon, talk with your doctor about your health history. They’ll determine whether Mestinon is right for you.
Health conditions or other factors that might interact with Mestinon include:
Blockage in your intestines or urinary system. Your doctor will likely not prescribe Mestinon if you have a blockage in your intestines or urinary system. To learn more, see the “When should I avoid Mestinon?” section above.
Kidney problems. Your kidneys help remove Mestinon from your body. If you have kidney problems, levels of Mestinon could build up in your body. This could raise your risk of side effects. If you have kidney problems, your doctor may prescribe a lower dosage of Mestinon for you.
Asthma. Mestinon may increase the amount of mucus in your airways and cause difficulty breathing. If you have asthma, your doctor will likely monitor you closely during your Mestinon treatment to make sure the prescribed dosage is right for you.
Pregnancy. It’s not known whether Mestinon is safe to take during pregnancy. If you’re pregnant or planning a pregnancy, talk with your doctor before starting Mestinon treatment.
Breastfeeding. It’s not known whether it’s safe to take Mestinon while breastfeeding. If you’re breastfeeding or planning to breastfeed, talk with your doctor about your options.
Allergic reaction. If you’ve had an allergic reaction to Mestinon or any of its ingredients, your doctor will likely not prescribe Mestinon. This is because taking the drug could cause another allergic reaction. You can ask your doctor about other treatments that may be better choices for you.
Taking certain steps can help you avoid interactions with Mestinon. Before starting treatment, talk with your doctor and pharmacist. Things to discuss with them include:
- Whether you drink alcohol or use cannabis.
- Other medications you take, as well as any vitamins, supplements, and herbs. Your doctor or pharmacist can help you fill out a
medication list . - What to do if you start taking a new drug during your Mestinon treatment.
It’s also important to understand Mestinon’s
If you have trouble reading or understanding this information, your doctor or pharmacist can help.
Taking Mestinon exactly as prescribed can also help prevent interactions.
If you still have questions about Mestinon and its possible interactions, talk with your doctor.
Questions you may want to ask your doctor include:
- Do I need to check with you before taking another medication or supplement during my Mestinon treatment?
- Does my risk of interactions depend on my dosage of Mestinon?
- Do I need to stop taking Mestinon before any surgeries?
To learn more about Mestinon, see these articles:
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Disclaimer: Healthline has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or another healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.