PYRIDOSTIGMINE

What is pyridostigmine (Mestinon)?

Pyridostigmine is a medication used to treat myasthenia gravis. Myasthenia gravis causes voluntary muscles to feel weak and tire quickly [1]. Muscles in the body use a substance called acetylcholine to contract. Without acetylcholine to excite the muscle, it stays limp. Pyridostigmine works to inhibit the breakdown of acetylcholine, leaving it available for the muscles to use.

Does pyridostigmine play a role in long-COVID?

Patients diagnosed with long-COVID can experience lightheadedness, postural orthostatic tachycardia syndrome (POTS), chest pain, and a fast heartbeat. To manage symptoms, several clinicians have turned to pyridostigmine as a treatment option. As some patients have fast heartbeats, pyridostigmine can help regulate them by allowing the acetylcholine to stay in the area where the cells can use it. Pyridostigmine has been mentioned to help control POTS in studies and hospital formulary guidelines [2,3].

Additionally, pyridostigmine may affect the chronic fatigue many long-COVID patients experience. According to one researcher, pyridostigmine can trigger the release of norepinephrine, the molecule responsible for mood and alertness. Activating norepinephrine propels blood back to the heart, supplies the muscles with more blood, and increases oxygen supply, leaving a person less fatigued [4].

Pyridostigmine is not a cure for long-COVID and will not eradicate it from the body. However, its use in POTS is well known and may offer symptom management for those suffering from long-COVID effects.

References:

¹https://www.mayoclinic.org/diseases-conditions/myasthenia-gravis/symptoms-causes/syc-20352036

²https://www.ohsu.edu/sites/default/files/2021-04/Long-COVID-19-Clinical-Guidelines-English-April-21-2021.pdf

³https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8146298/

⁴https://www.healthrising.org/treating-chronic-fatigue-syndrome/drugs/mestinon-for-chronic-fatigue-syndrome-me-cfs-fibromyalgia-pots-and-long-covid/