Veterinary drug · Drug monograph

Pyridostigmine: veterinary dose and monograph

Pyridostigmine is a veterinary drug. Longer-acting oral cholinesterase inhibitor — the maintenance drug for acquired myasthenia gravis. Indications include acquired myasthenia gravis (dogs, cats); reversal of non-depolarising neuromuscular blockade. This monograph lists 5 reference doses for dogs and cats, each with route, frequency and source.

At a glance

Drug class: Veterinary drug
Also known as: Mestinon, Regonol, Distinon, Pyridostigmine bromide
Species with doses: Dogs and Cats
General dose range: 0.5–3 mg/kg PO q8–12h — check the species tables for the indication
Routes: PO, IV
Last reviewed: 1 October 2026

Indications

Acquired myasthenia gravis (dogs, cats)
Reversal of non-depolarising neuromuscular blockade

Pyridostigmine dose by species

Doses are per administration unless stated. mg/kg doses scale with body weight; per-animal, per-quarter and infusion-rate doses are shown as the reference writes them.

Dogs

Pyridostigmine doses for dogs
Indication	Dose	Route	Frequency	Duration
Myasthenia gravis (oral)	0.5–3 mg/kg	PO	q8–12h (with food)	—
Myasthenia gravis — CRI (cannot take oral)	0.01–0.03 mg/kg/h	IV	CRI	—
Reversal of neuromuscular blockade	0.15–0.3 mg/kg	IV	as needed (with an anticholinergic)	—

Myasthenia gravis (oral): Papich 5e: 0.5–3 mg/kg PO q8–12h. Plumb’s p.1027: 0.5–3 mg/kg PO q8–12h with food, starting low and increasing slowly (Platt; Kornegay); 1–3 mg/kg q8–12h (Vernau); 0.5–1 mg/kg two to three times daily (LeCouteur) — spontaneous remission is common. Famotidine may reduce GI irritation.
Myasthenia gravis — CRI (cannot take oral): Plumb’s p.1027 (Vernau 2009): 0.01–0.03 mg/kg/h IV. Papich 5e: 0.02–0.04 mg/kg IV q2h.
Reversal of neuromuscular blockade: Papich 5e: 0.15–0.3 mg/kg IM or IV as needed.

Cats

Pyridostigmine doses for cats
Indication	Dose	Route	Frequency	Duration
Myasthenia gravis (oral) — low start	0.1–0.25 mg/kg	PO	q24h	—
Myasthenia gravis — CRI	0.01–0.03 mg/kg/h	IV	CRI	—

Myasthenia gravis (oral) — low start: Papich 5e: 0.1–0.25 mg/kg q24h PO. Plumb’s p.1027 lists higher regimens (0.5–3 mg/kg/day divided; Jones; Wheeler) and 1–3 mg/kg q8–12h (Inzana) — start low and titrate to strength and tolerance.
Myasthenia gravis — CRI: Papich 5e: 0.01–0.03 mg/kg/h IV.

Contraindications

Mechanical GI or urinary obstruction; bradyarrhythmias; asthma. Use cautiously with other cholinesterase inhibitors (organophosphates).

Adverse effects

Salivation, vomiting, diarrhoea
Muscle fasciculation, cholinergic weakness
Bradycardia

Monitoring

Muscle strength and regurgitation
Cholinergic signs
Acetylcholine-receptor antibody titre

Formulations and products

60 mg tablet
Oral syrup 12 mg/mL (60 mg/5 mL)
Injection 5 mg/mL

Before you use this dose

Reference doses for veterinary professionals. Confirm the dose against the product label, the patient’s condition, current guidance and local regulations before use; the attending veterinarian remains responsible for every clinical decision.

Frequently asked questions

What is the dose of Pyridostigmine for dogs?

Reference doses for Pyridostigmine in dogs: 0.5–3 mg/kg PO q8–12h (with food) (Myasthenia gravis (oral)); 0.01–0.03 mg/kg/h IV CRI (Myasthenia gravis — CRI (cannot take oral)); 0.15–0.3 mg/kg IV as needed (with an anticholinergic) (Reversal of neuromuscular blockade). Confirm against the label and the patient before use.

What is the dose of Pyridostigmine for cats?

Reference doses for Pyridostigmine in cats: 0.1–0.25 mg/kg PO q24h (Myasthenia gravis (oral) — low start); 0.01–0.03 mg/kg/h IV CRI (Myasthenia gravis — CRI). Confirm against the label and the patient before use.

When should Pyridostigmine not be used?