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Myasthenia Gravis

Mestinon and cardiac conditions



These Q and A`s have been extremely educational for me. In a recent response, it mentioned that "In general, mestinon is a safe medicine but patients with certain types of cardiac disease could have serious problems."

Can you elaborate on what type of cardiac patients would have problems with mestinon and the nature of those problems? Thank you.


Mestinon (pyridostigmine) prolongs the effects of acetylcholine, including slowing down the heart. One of the signs that someone might not tolerate mestinon is an already slow heartbeat. I am careful with this medication for people with arrhythmogenic heart disease. If the heart slows too much, it can actually pause or stop, so we try to watch how slow the heart gets with the drug. A normal heart rate is usually 60-80, although some people can tolerate 50-100 without any symptoms.

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Response by:

Robert W Neel, IV, MD Robert W Neel, IV, MD
Assistant Professor of Neurology
College of Medicine
University of Cincinnati