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Pyridostigmine is a parasympathomimetic and a reversible cholinesterase inhibitor. Since it is a quaternary amine, it is poorly absorbed in the gut and doesn't cross the blood-brain barrier.
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To reduce the risk of unwanted events, it is recommended to adjust Zithromax dose when it is used concomitantly with one of these medicines. Today, there is insufficient evidence of Zithromax interaction with anti-seizure medications Phenytoin or cardiac glycosides Digoxin. However, these drugs interact with other macrolide antibiotics, so precautions should be takenwhen they are used together with Zithromax.
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