Pyridostigmine

Favorite treatment.

I think Mestinon is my favorite.

It's not like it's not right for everyone, but because it can help both with dysmotility at kind of any level, like, even, like, reflux, swallowing, mostly constipation, and also help with dysautonomia symptoms, like the dizziness.

I don't know if you know this, but most people don't like taking multiple pills in a day.

They do not prove long-term prevention of falls, fractures, hospitalization, cognitive decline, or death.

The adult study that reaches a three-month threshold is BEYOND 2017, comparing mitadrine, pyridostigmine, and a combination in neurogenic orthostatic hypotension.

Orthostatic blood pressure drops and symptoms improved, and Midodrine had better symptom improvement than Pyridostigmine, but it was open-label and classified as Class IV evidence.

So, for neurogenic orthostatic hypotension, the practical recommendation is…

Reasonable for severe, symptomatic neurogenic orthostatic hypotension after non-drug steps.