title: Side effects of low-dose pyridostigmine bromide are not related to cholinesterase inhibition.
abstract: BACKGROUND
  Pretreatment with pyridostigmine bromide (PB) has become part of standard military procedures for protection against the effects of possible chemical warfare attack. The purpose of the work reported here was to quantify the type, intensity and frequency of side effects of low-dose PB, and to examine factors that predict the intensity and frequency of side effects.
  
  
  METHODS
  A double-blind, cross-over, placebo (PL)-controlled design was used. Of the 67 subjects, 33 received 30 mg PB every 8 h for 13 doses, and 34 received 60 mg on the same schedule. Order of PB and PL administration was counterbalanced.
  
  
  RESULTS
  Overall, side effects were mild, even at the 60-mg dose level. More side effects were reported when volunteers were taking PB than when they were taking placebo. Women reported more symptoms than men. Neither cholinesterase inhibition nor plasma levels of PB predicted side effect scores during the PB week; the best predictor of side effect scores during the PB week was side effect scores during the PL week.
  
  
  CONCLUSIONS
  PB is well tolerated by healthy young people, even when twice the recommended military dose is administered.
authors.affiliation: Midwest Research Institute, Kansas City, MO 64110, USA. mcg@planetkc.com
authors.forename: M R
authors.initials: MR
authors.lastname: Cook
authors.forename: M M
authors.initials: MM
authors.lastname: Gerkovich
authors.forename: A
authors.initials: A
authors.lastname: Sastre
authors.forename: C
authors.initials: C
authors.lastname: Graham
mesh_terms: D000293:Adolescent; D000328:Adult; D002800:Cholinesterase Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects* / Q000097:blood; D018592:Cross-Over Studies; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D011729:Pyridostigmine Bromide / Q000008:administration & dosage* / Q000009:adverse effects* / Q000097:blood
chemical_list: D002800:Cholinesterase Inhibitors; D011729:Pyridostigmine Bromide