# 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.

Source: https://vetmasterji.com/drugs/pyridostigmine · Last reviewed: 2026-10-01

## 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

> **Caution:** 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.

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## 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?

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

### What are the side effects of Pyridostigmine in animals?

Salivation, vomiting, diarrhoea; Muscle fasciculation, cholinergic weakness; Bradycardia.

## Sources

- Plumb's Veterinary Drug Handbook
- Papich 5e — Pyridostigmine Bromide
- Papich, Papich Handbook of Veterinary Drugs, 5th edition

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VetMasterJi is a clinical decision-support and education platform for veterinary professionals and students. It does not provide veterinary advice, diagnosis or treatment for specific animals. All drug doses, calculators and differentials are references that must be independently verified before clinical use; the attending registered veterinarian remains solely responsible for every clinical decision.