From the Research
Pyridostigmine (Mestinon) therapy for myasthenia gravis is not associated with any significant thrombosis risks. This medication is an acetylcholinesterase inhibitor that works by increasing acetylcholine levels at neuromuscular junctions, improving muscle strength in myasthenia gravis patients. Unlike some other medications used in neurological conditions, pyridostigmine does not affect blood coagulation pathways or platelet function, and there is no established mechanism by which it would increase thrombosis risk. The common side effects of pyridostigmine are primarily related to increased cholinergic activity, including gastrointestinal symptoms (nausea, vomiting, diarrhea, abdominal cramps), increased sweating, increased salivation, and occasionally bradycardia.
When managing patients on pyridostigmine, clinicians should monitor for these cholinergic side effects rather than thrombotic complications. If a myasthenia gravis patient has thrombotic events while on pyridostigmine, other risk factors or comorbidities should be investigated as the likely cause rather than the medication itself. According to a recent study 1, the effectiveness and side effects of pyridostigmine in the treatment of myasthenia gravis were assessed, and the results showed that pyridostigmine is effective in improving muscle strength, but its side effects are primarily related to increased cholinergic activity, with no mention of thrombosis risks.
In addition, another study 2 investigated the risk factors for potential drug-drug interactions in patients with myasthenia gravis and found that pyridostigmine-prednisone was one of the most frequent potential drug-drug interactions, but it was classified as moderate, and there was no mention of an increased risk of thrombosis.
Therefore, based on the available evidence, pyridostigmine can be safely used in patients with myasthenia gravis without a significant increase in thrombosis risk 1, 2. Clinicians should focus on monitoring for cholinergic side effects and managing other risk factors that may contribute to thrombotic events in these patients.