A child with myasthenia gravis complains of difficulty with chewing and facial movements. The physician orders neostigmine (Prostigmin) to improve muscle tone. What time should the patient take this medication to improve muscle tone while chewing?


• Neostigmine has a half-life of 50 minutes, so it should be taken about 30 minutes before meals to improve tone of the muscles of mastication.

• Neostigmine is an acetylcholinesterase inhibitor. It prevents the breakdown of acetylcholine to increase activation of nicotinic and muscarinic receptors, leading to muscle contraction.

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