Effects of Distigmine on the Mechanical Activity of Urinary Bladder Smooth Muscle

Abstract

Distigmine bromide (distigmine) is a reversible carbamate cholinesterase (ChE) inhibitor. Its principle clinical application is in the treatment of myasthenia gravis. Distigmine is also used as a remedy for dysuria and glaucoma. Its effectiveness in the management of dysuria has been demonstrated in several clinical reports. Distigmine may improve (enhance) urinary bladder smooth muscle (UBSM) contraction during micturition by inhibiting acetylcholine (ACh) decomposition. However, the pharmacological effects of distigmine on UBSM have not been adequately studied so far. In this review article, we summarize the reported effects of distigmine on the contractile responses elicited by exogenous and endogenous ACh in isolated UBSM preparations. We also discuss the effects of distigmine on the UBSM basal tone and the contractile response of UBSM to ATP, which is co-released with ACh from parasympathetic nerve terminals.

Association between Distigmine-induced Adverse Events and Serum Butyrylcholinesterase Level: A Multicenter Retrospective Study

“…It sometimes causes adverse events such as nausea and diarrhea because of elevated acetylcholine activity in the gastrointestinal tract. 1,2) Excessive acetylcholine activity due to distigmine can cause cholinergic crisis, which is a rare but potentially lifethreatening adverse event. 1,3,4) Among patients with cholinergic crisis caused by distigmine, 20％ require mechanical ventilation, and 6％ have potentially lifethreatening conditions.…”

“…1,2) Excessive acetylcholine activity due to distigmine can cause cholinergic crisis, which is a rare but potentially lifethreatening adverse event. 1,3,4) Among patients with cholinergic crisis caused by distigmine, 20％ require mechanical ventilation, and 6％ have potentially lifethreatening conditions. 3,4) Therefore, preventing severe adverse events associated with distigmine would improve patient outcomes.…”