Plasma pyridostigmine levels in myasthenia gravis

Plasma concentrations of pyridostigmine were measured after oral administration in 16 patients with myasthenia gravis. The levels varied greatly among both well- and poorly controlled patients, but were usually higher in the latter group. Absorption of the drug appears to be erratic; its clearance from the plasma is slow and its metabolism could involve an enterohepatic circulation. Drugs such as methylcellulose may prevent absorption. Three poorly controlled patients were studied on a high-dose alternate-day steroid regimen, and a marked decrease in pyridostigmine bioavailability on the same dose of drug was observed in all three. No such changes were demonstrated in a volunteer group taking a lower dose of steroids.