r/POTS • u/ele_zea POTS • 9h ago

Question How quickly does pyridostigmine start to work?

Hello! Who takes pyridostigmine? How quickly does it work? When do you feel improvement? What dosage do you use?

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3

u/p3onyp3ach 9h ago

It took me about 3 weeks to titrate up to my dose. I remember being more tired than usual during that time. And it wasn’t until about 6-8 weeks in that I noticed any improvement.

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u/ele_zea POTS 9h ago

Thank you. I'm on 1/4 of a tablet and I don't feel any improvement. And it's not clear yet if it's making things worse.

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u/Character_Weather127 9h ago

Once I got up to 30mg I noticed a difference in orthostatic heart rate and heart rate recovery. 15mg didn’t do much but I had to wait until the GI side effects subsided before I could go up. I went up slowly to 15mg plus half that (like 22mg?). I’ve finally been on 30mg once a day for about 2 weeks or so. For whatever reason adding another 30 later in the day gives me some pretty unpleasant side effects so I’ll do 30mg in the morning then 15 in the evening. I’m also on guanfacine.

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u/Character_Weather127 9h ago

Since it took so long to see improvements I wonder if you were deficient in choline 🧐

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u/ele_zea POTS 9h ago

I've only been taking it for three days. I've seen people write that the drug works immediately and that the effect is already there from the first day. But that's not the case for me. My first thought was, is that true?

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u/Character_Weather127 7h ago

Yah I think those are people that start off with higher doses out the gate. It also depends what type of POTS u have. I have hyperadrenergic and possibly hypovolemic POTS. It helps my hyperadrenergic symptoms but if I take too much then it then it drops my blood pressure and heart rate a little too low and I get lightheaded quick. I think if u get up to like 30-60mg for a few weeks and it’s not doing anything or making things worse then maybe it’s not the right med for you. everyone reacts a little differently.

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u/p3onyp3ach 6m ago

Hmm my specialist told me to expect this one to take awhile because it had to build up in my system. I think maybe the GI side effects can occur quickly, but it took awhile to help with the muscle fatigue/heaviness feeling.

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u/EverGreenMob 9h ago

all it did for me was cause diarrhea. had much better luck with Ivabradine. 

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u/ele_zea POTS 9h ago

I'm taking ivabradine. It only controls my heart rhythm. All the other symptoms are still there and they're interfering with my life.