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Distigmine is a long-acting reversible carbamate cholinesterase inhibitor and parasympathomimetic agent primarily used to treat neurogenic bladder dysfunction (underactive bladder), dysuria due to hypotonic or neurogenic bladder, and myasthenia gravis. It acts by inhibiting acetylcholinesterase (AChE), thereby increasing acetylcholine levels at neuromuscular junctions and muscarinic receptors. This leads to enhanced contraction of smooth muscle in the urinary bladder during micturition and improved detrusor function. Distigmine also binds directly and competitively to muscarinic receptors, which may contribute both to its therapeutic effects and side effects. Compared with related drugs such as pyridostigmine or neostigmine, it has a longer duration of action but carries a higher risk of drug accumulation and cholinergic crisis. Distigmine is available in several countries as the bromide salt (distigmine bromide) for oral administration[1][2][3][5][6][7][8].
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