What is Mestinon?
Mestinon (generic name pyridostigmine) is a medication that helps improve communication between nerves and muscles. It works by inhibiting acetylcholinesterase, an enzyme that breaks down acetylcholine — a key neurotransmitter in the autonomic nervous system. Mestinon is traditionally used to treat myasthenia gravis, a neuromuscular disorder. In Long COVID, it’s gaining attention as a potential treatment for POTS (Postural Orthostatic Tachycardia Syndrome).
How Mestinon Helps with Long COVID
- Supports Autonomic Nervous System Function – Enhances parasympathetic tone and helps rebalance autonomic dysfunction, especially in POTS.
- Reduces Tachycardia and Orthostatic Symptoms – Lowers standing heart rate, reduces palpitations and dizziness.
What the research says
Several studies suggest that Mestinon may help improve symptoms of POTS (postural orthostatic tachycardia syndrome), including fatigue, dizziness, palpitations, and fainting. Clinical trials and reviews report lower heart rates while standing and better symptom control—especially when combined with medications like propranolol. Many patients report meaningful relief, though some experience side effects or find it less effective. While more research is needed in Long COVID-related POTS, pyridostigmine is considered a well-studied treatment option for autonomic dysfunction.
Key Literature on Mestinon and Long COVID
Clinical Studies and Patient-Reported Outcomes showing positive effects:
- This clinical trial of 77 POTS patients found that pyridostigmine, when combined with propranolol or bisoprolol, led to significant improvement in orthostatic symptoms. While overall symptom relief was similar to beta-blockers alone, the propranolol + pyridostigmine group showed greater improvement in mental health quality of life. No major adverse effects were reported.
- This Retrospective review of 203 POTS patients found that 43% overall and 51% of those who tolerated the drug reported improvement. Significant improvements in fatigue (55%), palpitations (60%), presyncope (60%), and syncope (48%). Standing HR dropped from 94 to 82 bpm.
- This trial with 17 POTS patients found that a single 30 mg dose of pyridostigmine reduced standing heart rate from 119 to 100 bpm at 2 hours (p < 0.001) and improved symptom burden more than placebo. Seated heart rate over 4 hours was also lower with pyridostigmine, with no significant change in blood pressure.
- This study showed patient-reported outcomes from 3,925 patients. Mestinon had a Net Assessment Score of 41%. Helped 56.9% with POTS symptoms; especially effective in POTS-dominant cluster. Some users (17–21%) reported worsening.
Final Thoughts
Mestinon is emerging as a promising treatment option for Long COVID patients with POTS or other signs of autonomic dysfunction. Studies and patient reports show it may help reduce heart rate issues, fatigue, and dizziness, with a generally favorable safety profile when dosed properly, although some people may not tolerate it well and can experience side effects such as gastrointestinal upset or worsened symptoms. As it is a prescription medication, its use must be guided by a medical professional.