Drug interactions
Pilocarpine + Pyridostigmine
Severity: Moderate
Pilocarpine and Pyridostigmine: moderate interaction.
Last updated
For healthcare professionals — reference only. This page is a brief summary, not medical advice and not a substitute for official labeling or clinical judgement. Always verify before prescribing or dispensing.
Summary
Pilocarpine directly stimulates muscarinic receptors while pyridostigmine increases acetylcholine levels. Together they may increase cholinergic effects such as sweating, salivation, bradycardia, gastrointestinal cramping and bronchoconstriction.
What this interaction means in plain words
Pilocarpine and Pyridostigmine can affect each other. The combination is often manageable, but it may need a change of dose, a change of timing, or extra checks while both are taken.
Pilocarpine belongs to Miscellaneous; Pyridostigmine belongs to Central Nervous System.
Why it happens
Additive cholinergic effects from direct muscarinic agonism and cholinesterase inhibition.
What to do
Monitor heart rate, gastrointestinal and respiratory symptoms, and reduce the dose of either drug if cholinergic adverse effects appear.
What to ask your pharmacist
- Should I take them at different times of day?
- Does the dose of either medicine need to change?
- Is there anything I should avoid, such as alcohol or certain foods, while on both?
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Other interactions of Pyridostigmine
Other interactions of Pilocarpine
- Amitriptyline + Pilocarpine Moderate
- Atenolol-chlorthalidone + Pilocarpine Moderate
- Atenolol + Pilocarpine Moderate
- Atropine + Pilocarpine Moderate
- Betaxolol + Pilocarpine Moderate
- Bethanechol + Pilocarpine Moderate
Frequently asked questions
Can I take Pilocarpine with Pyridostigmine?
MediHelp rates the interaction as moderate. Pilocarpine and Pyridostigmine can affect each other. The combination is often manageable, but it may need a change of dose, a change of timing, or extra checks while both are taken. Pilocarpine directly stimulates muscarinic receptors while pyridostigmine increases acetylcholine levels. Together they may increase cholinergic effects such as sweating, salivation, bradycardia, gastrointestinal cramping and bronchoconstriction.
How serious is the interaction between Pilocarpine and Pyridostigmine?
MediHelp rates it moderate, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Monitor heart rate, gastrointestinal and respiratory symptoms, and reduce the dose of either drug if cholinergic adverse effects appear.
What other medicines interact with Pyridostigmine?
MediHelp also lists interactions of Pyridostigmine with, for example, Echothiophate iodide, Huperzine a, Neostigmine. The full list is on the Pyridostigmine page.
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