Distigmine is a cholinesterase (ChE) inhibitor used for the treatment of detrusor underactivity in Japan. Distigmine's pharmacological effects are known to be long-lasting, but the duration of its effect on urinary bladder contractile function has not been fully elucidated. The present study aimed to determine these effects in relation to the plasma concentrations of distigmine and its inhibition of ChE activities in blood, plasma, and bladder tissue. Intravesical pressures were recorded in anesthetized guinea-pigs for 12 h after the intravenous administration of saline or distigmine (0.01-0.1 mg/kg). Plasma distigmine concentrations were measured by liquid chromatograph-tandem mass spectrometry (LC-MS/MS), while ChE activities were assayed using 5,5′-dithiobis(2-nitrobenzoic acid). Distigmine (0.1 mg/kg) significantly increased the maximum intravesical pressure at micturition reflex for 12 h post-administration. In contrast, plasma distigmine was only detectable for 6 h post-administration in these animals and a one-compartment model calculated an elimination half-life of 0.7 h. However, bladder and blood acetylcholinesterase activities were significantly inhibited for 12 h after distigmine administration, although plasma ChE activities were not affected. The pharmacodynamic effects of distigmine thus persisted after its elimination from the circulation, indicating that it may bind to bladder acetylcholinesterase, producing sustained enzyme inhibition and enhancement of bladder contractility.Key words distigmine bromide; acetylcholinesterase; guinea-pig urinary bladder; pharmacokinetics; cystometry; intravesical pressure Distigmine bromide (distigmine) is a synthetic reversible cholinesterase (ChE) inhibitor. Its chemical structure consists of two molecules of pyridostigmine, connected by a hexamethylene structure. Clinically, this ChE inhibitor is principally used to treat Myasthenia gravis.1) In addition, glaucoma and underactive bladder are common indications for distigmine therapy in Japan. In particular, distigmine is one of the most important clinical urology therapeutics employed to treat lower urinary tract dysfunction and this compound is used for neurogenic underactive bladder ascribed to surgery, spinal cord injury, and diabetes. [2][3][4][5][6][7][8] It is also effective against drug-and prostate enlargement-induced dysfunctions of urinary excretion.9-13) Distigmine thus plays a significant role as a principal therapeutic for urinary excretion dysfunctions associated with an underactive bladder, whereas new generations of anticholinergic drugs or beta3 adrenoceptor agonists tend to be employed to treat conditions associated with an overactive bladder.Although a relatively large number of clinical reports have indicated the significant therapeutic efficacy of distigmine in urine storage disorders, there is a limited experimental evidence base relevant to its use in these conditions. In response to this, we have started to investigate the pharmacological effects of distigmine on urinary bladder contra...