A long-acting cholinesterase inhibitor
Distigmine
A long-acting medicine used for certain types of urinary retention and sometimes for myasthenia gravis.
What is Distigmine?
Distigmine is a long-acting medicine that boosts the body's nerve signal acetylcholine. It is used to help the bladder empty in some types of urinary retention, and less commonly to help muscle strength in myasthenia gravis. Because it is long-acting, its effects build up, and too much can cause a dangerous over-effect called a cholinergic crisis, with excess saliva, a very slow heart rate, tummy cramps and, importantly, breathing difficulty. For this reason it is used cautiously, in carefully judged amounts, with close supervision, and any signs of over-effect should be reported straight away.
Education and reference only. This is a plain-language guide to Distigmine — it deliberately contains no doses. Doses depend on the person, the brand and the reason for treatment, and belong with your prescriber. Always check the BNF, the product labelling (SmPC) and follow medical advice.
What it is
Distigmine is a cholinesterase inhibitor, a medicine that increases the activity of acetylcholine, a natural chemical the body uses to make muscles contract, including the bladder muscle. Because it works for a long time, it is used where a sustained effect is helpful, mainly to encourage the bladder to empty in certain types of urinary retention, and sometimes to support muscle strength in myasthenia gravis, a condition causing muscle weakness. It is a medicine that must be used carefully, because its long action means effects can build up. It is prescribed and supervised closely by a specialist.
How it works
Normally, the body breaks down acetylcholine quickly after it has done its job. Distigmine blocks the enzyme that breaks it down, so acetylcholine lasts longer and its effects are stronger. This helps muscles such as the bladder contract more effectively, and in myasthenia it helps weak muscles work better. Because distigmine is long-acting, the effect is sustained, but this also means that too much acetylcholine can build up, leading to an over-effect known as a cholinergic crisis, which is why doses are judged carefully and the person is watched closely.
Company & origin
Originated / developed by: Specialist manufacturer.
A long-acting medicine used in the UK for some types of urinary retention and, less commonly, for myasthenia gravis, under careful supervision.
Practical use
How to take Distigmine
General, dose-free guidance — always follow your prescriber's and the leaflet's specific instructions.
- Take it exactly as prescribed and never take extra or take it more often, as its effects build up over time.
- Take it on an empty stomach as advised, usually before food, so it is absorbed predictably.
- Seek urgent help for excess saliva, sweating, tummy cramps, a very slow heart rate or any difficulty breathing.
- Tell your specialist about any new muscle weakness, as in myasthenia this needs careful assessment.
- Keep all your follow-up appointments so your response and any over-effects can be checked.
Weighing it up
Advantages & disadvantages of Distigmine
Advantages
- Provides a long-lasting effect that can help the bladder empty in certain types of urinary retention.
- Can support muscle strength in myasthenia gravis when used carefully.
- Taken by mouth, with a steady, sustained action.
Disadvantages
- Its long action means effects can build up, risking a dangerous over-effect (cholinergic crisis).
- Can cause excess saliva, sweating, tummy cramps, a slow heart rate and breathing difficulty if there is too much effect.
- Needs careful, cautious use and close supervision.
Practical use
Good to know
The most important thing to understand about distigmine is the risk of having too much effect, known as a cholinergic crisis. Because the medicine is long-acting, its effects can build up, and an over-effect causes warning signs such as excess saliva and watering eyes, sweating, tummy cramps and diarrhoea, a very slow heart rate, muscle twitching and, most seriously, difficulty breathing. These signs must be reported and treated urgently, and a medicine called atropine is used as an antidote. Confusingly, in myasthenia, severe weakness can be caused either by too little or too much of this kind of medicine, so the cause needs to be worked out carefully by a specialist. Because of these risks, distigmine is used cautiously and under close supervision, and it should not be taken more often than prescribed.
Who should not take it / use with caution
- People with a blockage of the gut or urinary tract should not take it, as it could make this worse.
- People with certain slow heart rhythms should not take it, as it can slow the heart further.
- It is used with caution in people with asthma or other breathing problems.
- People who have had a serious allergic reaction to it should not take it.
Monitoring
- Watching closely for signs of too much effect, such as excess saliva, a slow heart rate or breathing difficulty.
- Reviewing how well the bladder empties or how muscle strength responds.
- Checking the heart rate and overall response at follow-up appointments.
Side effects
- Excess saliva, watering eyes, sweating and tummy cramps.
- Diarrhoea, nausea and a slow heart rate.
- Muscle twitching or weakness.
- Most seriously, a cholinergic crisis with breathing difficulty, which needs urgent treatment.
Key interactions
- It can add to the effects of other medicines that boost acetylcholine or slow the heart.
- Some medicines, such as certain muscle relaxants, interact with it, so tell your team about all your medicines.
- Medicines with 'drying' (antimuscarinic) effects can oppose how it works.
Available as: Tablets taken by mouth.
Answers
Distigmine: frequently asked questions
What is distigmine used for?
It is a long-acting medicine used to help the bladder empty in some types of urinary retention and, less commonly, to help muscle strength in myasthenia gravis.
What is a cholinergic crisis?
It is a dangerous over-effect of the medicine, with excess saliva, sweating, tummy cramps, a very slow heart rate and breathing difficulty, which needs urgent treatment.
Why must I not take extra?
Distigmine is long-acting, so its effects build up; taking extra raises the risk of a serious over-effect, so only ever take the amount prescribed.
Why is atropine mentioned with this medicine?
Atropine is used as an antidote if there is too much effect, so it is kept available; your team will manage this if needed.
Should I take it with food?
It is usually taken on an empty stomach, often before food, so it is absorbed predictably; follow the timing your specialist gives you.
Authoritative sources
- BNF
- NICE CKS
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