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**1. Introduction**

**Chapter 12**

**Abstract**

Interaction between

Oxidative Stress

Pyridostigmine Bromide and

*Verônica Farina Azzolin, Fernanda Barbisan,* 

*Euler Esteves Ribeiro, Raquel de Souza Praia* 

*and Ivana Beatrice Mânica da Cruz*

*Ivo Emilio da Cruz Jung, Cibele Ferreira Teixeira,* 

In this chapter the following topics will be addressed: (1) actions of the cholinergic system in the nervous system, commenting on acetylcholine metabolism and acetylcholinesterase metabolism; (2) acetylcholinesterase inhibitors as subtitle in this topic: pharmacological characterization of pyridostigmine bromide, mechanism of action, and therapeutic effect of the drug; (3) use of pyridostigmine bromide in Persian Gulf War; and (4) potential effect of pyridostigmine bromide in oxidative stress, addressing as subtitle the influence of pyridostigmine bromide on the superoxide-hydrogen peroxide imbalance model. Studies indicate that the interaction between pyridostigmine bromide and stressors could trigger genotoxicity, the mechanism associated with the induction of oxidative stress that leads to this side effect of this drug; however, this discussion needs to be better elucidated and may be more discussed as there is interaction between the pyridostigmine bromide and an endogenous oxidative imbalance caused by it or even by the possible interac-

tion of this with genetic variations present in the antioxidant metabolism.

**Keywords:** acetylcholinesterase inhibitor, oxidative stress, neurotoxicity,

Pyridostigmine bromide (PB) is a reversible acetylcholinesterase (AChE) inhibitor and the first line of choice for the treatment of symptoms associated with myasthenia gravis (MG) and other neuromuscular junction disorder prophylactic treatment in the Persian Gulf War, for prevention of post-traumatic stress and heat and pesticide exposure. However, evidence suggests that PB may be associated with Gulf War illness, characterized by the presence of fatigue, headaches, cognitive dysfunction, and respiratory, gastrointestinal, and musculoskeletal disorders [1–4]. However studies in animal models showed that if used without any association did not cause extensive cytotoxicity and genotoxicity to these animals. But the association of these drugs with other chemical or even physical agents caused cellular

superoxide dismutase 2, neuromuscular junction

## **Chapter 12**
