Universal reference book for medicines
Name of the preparation: KALIMIN 60 N (KALYMIN 60 N)

Active substance: pyridostigmine bromide

Type: Cholinesterase inhibitor

Manufacturer: Teva Pharmaceutical Industries (Israel) manufactured by KLOCKE PHARMA-SERVICE (Germany)
Description of the active substance:
This information is a reference and it is not enough that the drug has been prescribed by a doctor ..

PHARMACHOLOGIC EFFECT
Inhibitor of acetylcholinesterase and pseudocholinesterase.
It has an indirect cholinomimetic effect due to reversible inhibition of cholinesterase and potentiation of the action of endogenous acetylcholine. It improves neuromuscular transmission, strengthens the tone and peristalsis of the gastrointestinal tract, raises the tone of the bladder, bronchi, the secretion of the exocrine glands. Causes a bradycardia.
PHARMACOKINETICS
After ingestion, it is poorly absorbed from the digestive tract.
Unlike neostigmine and physostigmine, it is not hydrolyzed by cholinesterase. It is excreted in the urine.
INDICATIONS
Myasthenia gravis and myasthenic syndrome, postoperative intestinal atony, atonic constipation, impaired emptying of the bladder after gynecological operations and childbirth.

Elimination of the effect of nondepolarizing curare-like remedies.

DOSING MODE
When ingestion - 60-180 mg 2-4 times / day, if necessary, increase the dose.

Parenteral (sc, in / m or in / in) is administered 5 mg up to 5 times / day.

In order to stop myorelaxation - iv slowly in a dose of 5 mg (sometimes in combination with atropine at a dose of 500 mcg).
In some cases, these doses are divided into 2 injections.
SIDE EFFECT
From the cardiovascular system: bradycardia.

From the digestive system: nausea, vomiting, diarrhea, stomach cramps, increased salivation.

From the side of the central nervous system: muscle twitching, muscle lethargy, miosis.

On the part of the respiratory system: an increase in the tone and secretion of the bronchi.

Allergic reactions: skin rash.

CONTRAINDICATIONS
Mechanical obstruction of the intestine or urinary tract, bronchial asthma, hypersensitivity to pyridostigmine bromide.

PREGNANCY AND LACTATION
Use during pregnancy and lactation is possible only on strict indications.

APPLICATION FOR FUNCTIONS OF THE LIVER
Particular caution should be exercised when used in patients with kidney disease.

APPLICATION FOR VIOLATIONS OF THE FUNCTION OF KIDNEYS
Particular caution should be exercised when used in patients with liver disease.

SPECIAL INSTRUCTIONS
In patients with gastric ulcer, hyperthyroidism, heart failure in the phase of decompensation, and with myocardial infarction, pyridostigmine bromide is used only after a careful comparison of the risk of side effects and the expected beneficial effect.
Particular caution should be exercised when used in patients with bradycardia, diabetes, kidney disease, Parkinsonism, liver disease, and after operations on the gastrointestinal tract.
It is recommended to select the time of taking pyridostigmine bromide in such a way that its maximum effect coincides with the cycle of physical activity of the patient.
It should be remembered that the lack of an expected response to treatment may be a consequence of an overdose.
Impact on the ability to drive vehicles and manage mechanisms

When using pyridostigmine bromide, you should avoid driving the car and other activities that require high concentration of attention, rapid psychomotor reactions.

DRUG INTERACTION
Pyridostigmine bromide is an antagonist of nondepolarizing muscle relaxants and enhances the effect of depolarizing muscle relaxants.

M-holinoblokatory, ganglioblokatory, quinidine, novocainamide, local anesthetics, tricyclic antidepressants, antiepileptic and antiparkinsonian drugs reduce the action of pyridostigmine bromide.

Atropine is able to neutralize the m-cholinergic effect of pyridostigmine (but not its effect on skeletal muscles).

Pyridostigmine bromide can enhance the action of derivatives of morphine and barbiturates.

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