Pyridostigmine bromide – GWI and ME/CFS

A reader message me with a drug that I was not familar with

Hello, my brother has CFS and I would like to ask you a question. We talked to a doctor at the ‘…..’ hospital in Germany who specializes on CFS. The doctor suggested taking Pyridostigmine bromide. What are your thoughts on that?

This is a drug that I am not familiar with and thus interested in finding out more.

First, what is it’s typical use:

Pyridostigmine bromide (PB) is a drug used during the Gulf War as a pretreatment to protect troops from the harmful effects of nerve agents. It has been used for more than 40 years in the routine treatment of myasthenia gravis and may be used following surgery in the reversal of neuromuscular blockade (Williams, 1984).

Gulf War and Health: Volume 1. Depleted Uranium, Sarin, Pyridostigmine Bromide, Vaccines. (From NIH)

So, if the brother had been involved in the Gulf War, there seem to be some logic to this suggestion. However, constructive logic usually have risk and is inferior to doing research. What I found sent my air-raid alarms sounding.

Results indicate that more than 21 Pyridostigmine Bromide (PB) pill exposure was associated with consistent reporting of fatigue, pain, and cognitive/mood symptoms as well as the development of six additional symptoms over time. Veterans reporting exposure to more than 21 PB pills were more than 8 times as likely to consistently meet the criteria for Chronic Multisymptom Illness over time.

Health symptom trajectories and neurotoxicant exposures in Gulf War veterans: the Ft. Devens cohort [2022]

Ah, ME/CFS had yet another name: Chronic Multisymptom Illness.

And the bad news went on:

Difference of Opinion?

A reader pointed me to Mestinon on which presents some interesting reads. My ground rules have always been to rely on gold standard sources, that is, peer-reviewed PUBMED articles.

This page does cites issues seen:  gastrointestinal symptoms , Multiple chemical sensitivity (MCS). This page also cites:  there are no clinical trials of Mestinon in ME/CFS. Evidence for it was:

My typical reading of OLD thin results is that there were follow up studies that showed no effect or negative effects, hence never submitted for publication (or not accepted by publishers).

Revisited PubMed

PubMed failed me because it did not find this drug by alternative names…

Bottom Line

I would declined, and actually ask the doctor for published studies that shows it would help. The evidence is that it would make the symptoms worst. A single dose appears to help, the evidence of the cumulative effect of multiple doses are a worsening of the symptoms.

This is one of the few cases that I would consider writing to the licensing authorities if the doctor response to being presented with the above information is arrogance.

For your brother, I would suggest getting an appropriate microbiome test (being in Germany, my choice would be from the UK), and using “Dr. Artificial Intelligence” at . Dr.A.I. fees are reasonable (free), with immediate availability once you get the test results. So far the feedback from people using him has been very positive.

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