Pyridostigmine military personnel

There are important differences between on-target military attacks against relatively well-protected armed forces and nerve agent attacks initiated by terrorists against a civilian population. In contrast to military personnel, civilians are unlikely to be pre-treated with pyridostigmine and protected by personal protective equipment (PPE). Furthermore, the time after exposure when specific therapy can first be administered to civilians is likely to be delayed. Even conservative estimates suggest a delay between exposure and the first administration of atropine/oxime of at least 30 min. The clinical importance of this delay is discussed below. 

Fig. 6-1. A pyridostigmine blister pack containing 21 30-mg tablets, along with the carrying sleeve. This is the nerve agent pyridostigmine pretreatment set (NAPPS) that was used by designated military personnel during the Persian Gulf War.

To use this potentially life-saving drug correctly, military personnel must carefully follow instructions and use the drug only xmder specific circumstances. For example, if US troops faced the threat of exposure to soman, then they would be given instructions to take pyridostigmine bromide every 8h before the anticipated exposure. Soldiers would be warned that the drug is not effective and should not be taken at the time of, or after, exposure to soman. 

A leaflet that explains the drug s use, benefits, and side effects will be provided to military personnel when the drug is distributed. The leaflet advises that pyridostigmine bromide should not be used by persons who have a history of bowel or bladder obstruction, or sensitivity to certain medicines used during surgery (like physo-stigmine). Side effects that may occur include stomach cramps, diarrhea, nausea, frequent urination, headaches, dizziness, shortness of breath, worsening of peptic ulcer, blurred vision, and watery eyes. 

---