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Appendix E

Operational Use of Pyridostigmine Bromide

	In 1985, TAC initiated the ground testing of all aircrews with 
pyridostigmine bromide. Reported side effects were so low (<1%) that testing was 
discontinued in 1987. During Operation Desert Storm, some units were ordered to 
begin pyridostigmine bromide prophylaxis. The following results were provided 
by LtCol Joseph M. Palma from a questionnaire he prepared and distributed at a 
deployed Wing.
Questionnaires distributed - 156//returned = 106 (return rate 68%)

Findings:
	-Compliance was poor -- only 9.5% completed the full directed course of 7 
days. 61% had quit the prophylaxis after three days. 5.7% did not begin 
prophylaxis.
	-Side effects were prevalent in an uncontrolled assessment (62% reported some side effects)

	Headaches			8%
	Rash				2%
	Somnolence			5%
	Weakness			5%
	Salivation/Tearing		0%
	Bloated stomach			6%
	Belly cramps			10%
	Loose bowel movements		18%
	Two or more stools/day		9%
	Muscle cramps or twitching	4%

	-The most common side effects were gastrointestinal -- 40%
	-Pyridostigmine side effects had no adverse impact on the mission -
100% said no missions were cancelled due to side effects.
	-Side effects were a significant but not predominant reason for poor 
compliance -- of the 91% who stopped prophylaxis before authorized, 36.5% stated 
side effects were the reason.

In a less formal report, an F-16 wing SME estimated only 20% compliance with 
the order to take pyridostigmine among pilots. Of those, 30-40% complained of GI 
side effects (abdominal cramping and nausea). Those who did not comply cited 
uncertainty about a strange medication and the apparent low threat of chemical 
contact as reasons.

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