The best replacement for pyridostigmine is edrophonium.

The best alternatives to pyridostigmine are rated as following:
★★★★★  edrophonium
★★★  donepezil
★★★  physostigmine

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Speaking about pyridostigmine, one probably shouldn't forget about ketamine.

Other search terms related to pyridostigmine and their ratings are:
★★★★★ ketamine
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Google Trends

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pyridostigmine
edrophonium
donepezil