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Pyridostigmine [Mestinon] For Exercise Intolerance Treatment In Preload Failure(conference abstract)


Senior Member
I'm posting this in the ME/CFS section because the abstract mentions chronic fatigue syndrome and POTS.


First published online May 02, 2016 as doi:10.1164/ajrccm-conference.2016.193.1_MeetingAbstracts.A5664
Pyridostigmine For Exercise Intolerance Treatment In Preload Failure
Rudolf K. Oliveira , MD, PhD 1 , Julie A. Tracy , MSc 2 , Abbey L. Karin , MEd 2 , Aaron Waxman , MD, PhD 2 , David Systrom , MD, 2 ,

Publication Date: 2016

Recently we saw an excellent paper by Systrom's group which didn't explicitly mention CFS, though it did mention that a minority of the patients were diagnosed with POTS: Unexplained exertional dyspnea caused by low ventricular filling pressures: results from clinical invasive cardiopulmonary exercise testing

This conference abstract appears to be a follow-up study examining the use of pyridostigmine (Mestinon) in patients with exercise intolerance and preload failure. 78% response rate is claimed.



Senior Member
@Sidereal have you tried this med before?
I tried this last year at a lower dose of 60mg but didn't remember doing anything good. Perhaps another trial is in order.

I think it was part of my Jay Goldstein trial and error drug exercise. I know he used it at the time BBTB was written but by the time TTB came out he mentioned he stopped using it cuz he thought it was neurotoxic. Having said that I could probably deal with the possible neurotoxicity if it was a "magic bullet" type drug for me.

Interesting post.


Senior Member
Mestinon is the first treatment suggested by the neurologist I consulted for OI.

His instructions were to start with 10 mg once daily and build up in weekly increments of 10 mg (ie week 1, 10 mg 1x daily, week 2, 10 mg 2x daily, week 3, 10 mg 3x daily) to a final dose of 60 mg (20 mg 3x daily).

I never got past the first 10mg. It caused intolerable drowsiness. I persisted thinking this would settle down but it never did so in the end I gave it away.

The neurologist was very surprised by this reaction.