Public Health

Pyridostigmine Bromide and Gulf War Veterans

VA and research organizations evaluated exposure to pyridostigmine bromide (PB), an anti-nerve agent pill Gulf War Veterans may have taken during military service, as a possible cause of chronic multisymptom illnesses.

VA has concluded that the evidence does not support an association. Read the Federal Register notice for the rationale behind VA’s decision.

VA still, however, presumes certain medically unexplained illnesses are related to Gulf War service without regard to cause.

Pyridostigmine bromide (PB)

• Anti-nerve agent pill used during the Gulf War as a pretreatment to protect military personnel from death in an attack with the nerve agent soman.
• Supplied in the Gulf War as 21-tablet blister pack, with prescribed dosage as one 30-mg tablet every 8 hours. Veterans’ actual exposure is not known, because pills were self-administered and there are few examples in individual or unit health records from the Department of Defense.

VA benefits

Gulf War Veterans may be eligible for a variety of VA benefits, including a Gulf War Registry health exam, the Airborne Hazards and Open Burn Pit Registry, health care, and disability compensation for diseases related to military service. Their dependents and survivors also may be eligible for benefits.

Gulf War Veterans are eligible for presumptive conditions due to exposure to airborne hazards. Find these conditions in the Health Care and Benefits section of the Airborne Hazards and Burn Pit Exposures web page.

Learn more about benefits related to Gulf War service.

Research on pyridostigmine bromide (PB)

VA continues to monitor Gulf War Veterans’ health issues and conduct research. Below are reports on past research on PB and Gulf War Veterans starting with the most recent report.

• Health and Medicine Division (HMD) (formally known as the Institute of Medicine) of the National Academy of Sciences, Engineering, and Medicine Gulf War and Health report Health Effects of Serving in the Gulf War (2010)
  Disagreed with the Research Advisory Committee's conclusion in its 2008 report that chronic multisymptom illness is caused by exposure to PB and pesticides. Concluded that current available evidence is not sufficient to establish a causative relationship between chronic multisymptom illness and any specific drug, toxin, plume or other agent, either alone or in combination.
• Research Advisory Committee on Gulf War Veterans' Illnesses report Gulf War Illness and the Health of Gulf War Veterans (7.2 MB, PDF) (2008)
  Found evidence of an association between exposure to PB and pesticides and multisymptom illness consistent with "Gulf War Illness."
• HMD Gulf War and Health report Depleted Uranium, Sarin, Pyridostigmine Bromide, and Vaccines (2000)
  Further research is needed on PB and other agents, as well as on genetic factors and long-term health effects.
• Rand Corporation Review of the Scientific Literature as It Pertains to Gulf War Illnesses (1999)
  PB carries "risks that cannot with certainty be ruled out" as possible contributors to the development of unexplained or undiagnosed illness in some Gulf War Veterans.
• HMD report Health Consequences of Service During the Persian Gulf War: Recommendations for Research and Information Systems (1996)
  No documented long-term side effects.
• Presidential Advisory Committee (PAC) report Gulf War Veterans’ Illnesses (48 KB, PDF) (1996)
  "It is unlikely that health effects reported today by Gulf War veterans are the result of exposure simply to PB. Ongoing federally funded studies should help the scientific community draw conclusions about the synergistic effects of PB and other risks."

View more research on health effects of Gulf War service.

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