Renal Impairment: Pyridostigmine is mainly excreted unchanged by the kidney. Therefore, lower doses may be required in patients with renal disease and treatment should be based on titration of drug dosage to effect.
Use in Pregnancy & Lactation: Reproduction studies in laboratory animals have not indicated any risk to the fetus but no controlled studies have so far been conducted in pregnant women. Therefore, Mestinon should only be used during pregnancy strictly as directed, with careful dosing and under medical supervision.
Since the possibility of pyridostigmine diffusing into breast milk cannot be ruled out, nursing mothers are advised to refrain from breastfeeding their babies during treatment.