You should not use pyridostigmine if you are allergic to it, or if you have a bladder or bowel obstruction.

To make sure you can safely take pyridostigmine, tell your doctor if you have any of these other conditions:

asthma;

kidney disease;

an ulcer or other serious stomach disorder;

high blood pressure, heart disease;

overactive thyroid; or

a history of seizures.

It is not known whether pyridostigmine will harm an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant while using this medication. It is not known whether pyridostigmine passes into breast milk or if it could harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby.

Drugs interaction 

Tell your doctor about all other medicines you use, especially:

atropine (Atreza, Sal-Tropine);

belladonna (Donnatal, and others);

benztropine (Cogentin);

clidinium (Quarzan);

clozapine (Clozaril, FazaClo);

dimenhydrinate (Dramamine);

methscopolamine (Pamine), scopolamine (Transderm Scop);

glycopyrrolate (Robinul);

mepenzolate (Cantil);

bladder or urinary medications such as darifenacin (Enablex), flavoxate (Urispas), oxybutynin (Ditropan, Oxytrol), tolterodine (Detrol), or solifenacin (Vesicare);

bronchodilators such as ipratropium (Atrovent) or tiotropium (Spiriva);

cold medicine, allergy medicine, or sleeping pills that contain an antihistamine such as diphenhydramine (Tylenol PM) or doxylamine (Unisom);

heart rhythm medication such as quinidine (Quin-G), procainamide (Procan, Pronestyl), disopyramide (Norpace), flecaininde (Tambocor), mexiletine (Mexitil), propafenone, (Rythmol), and others;

irritable bowel medications such as dicyclomine (Bentyl), hyoscyamine (Hyomax), or propantheline (Pro Banthine);

medicine to treat Alzheimer's dementia, such as donepezil (Aricept), rivastigmine (Exelon), or tacrine (Cognex); or

a steroid such as betamethasone (Celestone) or dexamethasone (Cortastat, Dexasone, Solurex, DexPak).

This list is not complete and other drugs may interact with pyridostigmine. Tell your doctor about all medications you use. This includes prescription, over-the-counter, vitamin, and herbal products. Do not start a new medication without telling your doctor.

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat. Stop using pyridostigmine and call your doctor at once if you have any of these serious side effects:

extreme muscle weakness, muscle twicthing;

slurred speech, vision problems;

severe vomiting or diarrhea;

cough with mucus;

confusion, anxiety, panic attacks;

seizure (convulsions); or

worsening or no improvement in your symptoms of myasthenia gravis.

Less serious side effects may include:

cold sweat, pale skin;

urinating more than usual;

watery eyes;

mild nausea, vomiting, or upset stomach;

warmth or tingly feeling; or

mild rash or itching.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects.