For myasthenia gravis, when should pyridostigmine be given to maximize benefit?

• A. 2 hours after meals
• B. 1 hour before meals
• C. At bedtime
• D. With meals

Answer: (B)

Timing pyridostigmine to align with meals is essential because this drug boosts neuromuscular transmission to improve swallowing and chewing, which are often weakest in myasthenia gravis during eating. Pyridostigmine is a longer-acting acetylcholinesterase inhibitor that increases acetylcholine at the neuromuscular junction. It typically begins working within minutes, peaks about one hour after oral dosing, and lasts several hours. Giving it roughly one hour before meals ensures its peak effect coincides with eating, maximizing strength when it’s most needed and reducing the risk of aspiration. Administering it after meals or at bedtime would miss the mealtime window, and taking it with meals may not provide peak benefit during eating.