Q. Why were troops given Pyridostigmine Bromide (PB) during
the 1990-1991 Gulf War?
A. During Operation Desert Storm, the threat of use of nerve agents by
Iraq was very high. After careful deliberation by a specially constituted
human-use review committee of the Food and Drug Administration, it was
determined that the pretreatment could help save the lives of many Service members
if nerve agents were used. Approval for the use of pyridostigmine bromide
was based on extensive scientific information that supported the safety
and effectiveness of pyridostigmine bromide as a preventive treatment.
Pyridostigmine bromide is not an exotic or experimental drug. The Food
and Drug Administration approved it in 1955 for use in treating myasthenia
gravis, a neuromuscular disease that causes muscle weakness and fatigue.
However, when approved for use in the Gulf, the approval was as an investigational
new drug. This classification means that pyridostigmine bromide had not
been formally approved for general commercial marketing as a nerve gas
There was no effort to withhold information from the troops or the public.
In fact, pyridostigmine bromide use was widely reported by the news media
at the time. The Department of Defense believes that most individuals
knew they were taking an oral drug to counter the effects of a possible
attack with nerve agents. However, troops did not receive enough information
about the possible side effects of pyridostigmine bromide. Information
was prepared for distribution in the field, but it did not arrive before
The Defense Department estimates that approximately 250,000 personnel
took at least some pyridostigmine bromide during the 1990-1991 Gulf War. During
the 1990-1991 Gulf War, all U.S. troops were to have received packets containing
pyridostigmine bromide pills.
Actual administration of the pre-treatment was decentralized in nuclear,
biological chemical (NBC) and not medical channels. It was intended to
be self-administered upon a unit commander's order. We know that in some
units, pyridostigmine bromide administration was carefully monitored,
while in others, it was not. However, accurate assessments of actual pyridostigmine
bromide use are difficult because no specific records were kept of self-administered
To date, the Food and Drug Administration has recalled none of the drugs
or vaccines administered by the military. If you would like more information
on pyridostigmine bromide you may contact the Defense Personnel Support
Center at (215) 737-5768.
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