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LTC Jill R. Keeler, AN; COL Charles G. Hurst, MC, USA; COL Michael A. Dunn, MC, USA
US Army Medical Research Institute of Chemical Defense Aberdeen Proving Ground, Md

JAMA. 1991;266(23):3283.

	Since this article does not have an abstract, we have provided the first 150 words of the full text PDF and any section headings.

In Reply.

—We limit our response to Dr Sarno to issues raised about pyridostigmine. Clearly, this is of concern as the number of women in military service increases and the threat of chemical warfare in the world persists. Since the safety of pyridostigmine during pregnancy or lactation in humans has not been established, the use of pyridostigmine in women who may become pregnant requires weighing the drug's potential benefits (ie, survival in a nerve agent attack) against its possible hazards to mother and child.

Sarno stated that pyridostigmine is classified as risk factor C because no controlled studies in women have been done, or because studies in women and animals are not available.¹ In fact, controlled studies in rats and monkeys have been done and showed no direct teratogenic effects or significant ill effects on fertility and reproductive performance (Hoffman-La Roche Inc, proprietary information).²

Importantly, pyridostigmine has been . . . [Full Text PDF of this Article]

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