Pyridostigmine

Boost energy, improve exercise tolerance, and slow down a rapid heart rate

Take back control of your health with pyridostigmine, an FDA-approved medication demonstrating symptom relief for people living with POTS, Long COVID and ME/CFS.

Only pay if your prescription is approved.

Stabilize your heart rate

Pyridostigmine helps to alleviate a rapid heart rate that is constant or occurs when standing, helping to bring back some normalcy for Long COVID and ME/CFS patients experiencing autonomic dysfunction.

Boost cognitive function

Pyridostigmine helps maintain higher ACh levels, potentially benefiting muscle function and strength as well as cognitive clarity for those with Long COVID and ME/CFS.

Improve exercise tolerance 

Pyridostigmine may improve exercise capacity and neurovascular dysregulation, helping to get you moving again.

Brain Fog

Poor cognition

Post-exertional Malaise

Dizziness

Fatigue

Autonomic dysfunction

Learn more about the promising benefits of pyridostigmine

Early research suggests pyridostigmine is a promising treatment option for those with autonomic dysfunction, exercise intolerance, and muscle fatigue associated with Long COVID and ME/CFS. Adding pyridostigmine to your treatment arsenal may help improve symptoms and allow you to focus on brighter days ahead.

  • Pyridostigmine, a medication classified as a cholinesterase inhibitor, operates by blocking the breakdown of acetylcholine, a crucial neurotransmitter for communication between nerve cells and muscles. By elevating acetylcholine levels, pyridostigmine enhances communication within the nervous system and reinforces muscle contractions.

    In conditions such as POTS and ME/CFS, where autonomic dysfunction is prevalent, pyridostigmine's mode of action may be beneficial. It boosts parasympathetic (vagal) tone, potentially alleviating symptoms like orthostatic intolerance (difficulty standing due to blood pressure fluctuations) and promoting stability in heart rate variability.

  • Pyridostigmine may offer symptom relief for those with Long COVID and ME/CFS, especially in those patients with autonomic nervous system dysfunction, such as dysautonomia. Symptoms that may see improvement include:

    • Lightheadedness

    • Dizziness

    • Rapid heartbeat

    • Chest palpitations

    • Muscle weakness

    • Muscle fatigue

    • Cognitive dysfunction, or brain fog

    • Post-exertional malaise (PEM)

  • Pyridostigmine is safe and generally well-tolerated by patients experiencing a range of conditions. However, as with most medications, side effects can occur with pyridostigmine and include:

    • Digestive issues including nausea, vomiting, diarrhea, and abdominal cramps

    • Increased saliva production

    • Increased mucus production

    • Symptoms of peristalsis (digestive muscle contractions) which can include trouble swallowing, heartburn, and chest pain

    • Increased sweating

    • Muscle cramping or twitching

    • Blurred vision

    • Increased urination

    • Fatigue

    • Mild allergic reactions

    • Muscle weakness

    • Anxiety 

    • Watery eyes

Ready to try pyridostigmine?

Take advantage of pyridostigmine in three easy steps.

Fill out a condition assessment.

1

Share your symptoms, current conditions, allergies and complete a health assessment.

Our clinicians will review your health profile.

2

An expert clinician from RTHM Direct will review your assessment within 1 business day and prescribe the requested medication if it is a good fit for your case. Pay $0 unless medication is prescribed.

Get approved and pick-up your prescription.

3

Pick up and pay for the prescribed treatments at your preferred pharmacy using the coupon card we provide.

Pricing

Pyridostigmine

$59

Online Consultation

Pyridostigmine

Pay at pharmacy

Total

$59.00

Only pay if your prescription is approved. A 30-day supply of pyridostigmine is estimated at $30, price varies per pharmacy.

RTHM patient voices 

“RTHM has given me hope. After struggling with Long COVID for two years, even with the help of a Long COVID clinic, I was still doing all of my own research and trying to keep my doctors advised of the state of the art in treatments.”

— Stuart S.

How do RTHM clinicians prescribe pyridostigmine?

Every patient’s journey towards health is unique, especially when managing chronic, complex conditions like Long COVID and ME/CFS. That is why we start patients at lower doses and gradually increase them to find the most effective dose with the fewest side effects.

If you are taking pyridostigmine for the first time, you will initially receive a 30-day prescription at a lower dose, along with clear instructions on how to safely increase your dosage. Once you find your stable dose, you will receive a 60-day prescription at this stable dose.

If you have already found your stable dose of pyridostigmine, you will have the option to receive a 90-day supply of medication.

Safety is our top priority

The eligibility criteria, the dosing protocols and the treatment guides for every treatment offered via RTHM Direct have been designed by a team of clinicians and pharmacists focused on complex illnesses.

As we continue to navigate the complexities of Long COVID, ME/CFS, and other chronic conditions, we are upholding the highest patient safety standards while expanding access to treatments.

And in case you missed anything.

  • Pyridostigmine is FDA-Approved to treat muscle weakness common with myasthenia gravis, but also shows promise in stabilizing heart rate and blood pressure changes commonly seen in different forms of dysautonomia, such as postural orthostatic tachycardia syndrome (POTS).

  • Certain medical conditions can affect how pyridostigmine works. Notify your prescribing physician if you have any of the following conditions:

    • If you have known blockage in your intestines. Pyridostigmine can increase the muscle contractions in the intestines, which can be dangerous when you have a blockage.

    • If you have known blockage in your urinary system. Pyridostigmine can increase the need to urinate, which can be dangerous if there is a blockage in your urine flow.

    • Those with an allergy to pyridostigmine and any of its ingredients should avoid taking pyridostigmine.

    • Your kidneys are responsible for removing pyridostigmine from your body. If you have kidney problems, pyridostigmine can build up in the body, increasing the risk of side effects. 

    • Pyridostigmine can increase mucus production in the airways and can make breathing difficult, especially for those with asthma or other lung diseases. 

    • Pyridostigmine interacts with many medications including anticholinergics, beta-blockers, acetylcholinesterase medications, tricyclic antidepressants, corticosteroids, and diphenhydramine. Check with your pharmacist for any possible interactions with current medications.

  • Because pyridostigmine affects the heart rate, your prescription will start with a lower dose and gradually increase as tolerated. Regular monitoring and logging of your heart rate and blood pressure is recommended to ensure you do not increase your dose too much.

  • If you miss a dose, take it as soon as possible. If you are close to the time of your next dose, wait to take the next dose and then resume your normal dosing schedule. Do not “double-up” the dose.

  • Pyridostigmine is safe and generally well-tolerated by patients experiencing a range of conditions. However, as with most medications, side effects can occur with pyridostigmine and include:

    • Digestive issues including nausea, vomiting, diarrhea, and abdominal cramps

    • Increased saliva production

    • Increased mucus production

    • Symptoms of peristalsis (digestive muscle contractions) which can include trouble swallowing, heartburn, and chest pain

    • Increased sweating

    • Muscle cramping or twitching

    • Blurred vision

    • Increased urination

    • Fatigue

    • Mild allergic reactions

    • Muscle weakness

    • Anxiety 

    • Watery eyes

  • Keep this medication in the container provided by the pharmacy. Ensure it is properly closed and out of the reach of children. Store at room temperature and away from excess heat and moisture (not in the bathroom).

  • Our selected medications are low-risk and research-backed to improve symptoms of chronic complex conditions.

    Each medication assessment is approved by a team of expert clinicians and pharmacists, ensuring the highest standards of patient safety.