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Mestinon
Pyridostigmine
$102.00
60mg · 6 × 20 tablets · 1 month supply
BrandBranded medicine· By ICN pharma
$102.00 per month
How long a supply?
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Annual cost
$1241a year at this pack size
Prescription required
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FDA boxed warningRisks with improper use of pyridostigmine bromide
After Exposure to Soman, Use Atropine and Pralidoxime
Pyridostigmine bromide is for use as a pretreatment for exposure to soman nerve agent. Pyridostigmine bromide alone will not protect against exposure to soman. The efficacy of pyridostigmine bromide is dependent upon the rapid use of atropine and pralidoxime (2-PAM) after soman exposure.
Always Use Protective Garment(s)
Primary protection against exposure to chemical nerve agents is the wearing of protective garments including masks, hoods, and overgarments designed specifically for this use. Individuals must not rely solely upon pretreatment with pyridostigmine bromide and on the antidotes atropine and pralidoxime (2-PAM) to provide complete protection from poisoning by soman nerve agent.
Pyridostigmine Bromide as Pretreatment Only
If pyridostigmine bromide is taken immediately before exposure (e.g., when the gas attack alarm is given) or at the same time as poisoning by soman, it is not expected to be effective and may exacerbate the effects of a sub-lethal exposure to soman. Do not take pyridostigmine bromide after exposure to soman.
FOR MILITARY MEDICAL USE ONLY
If taken immediately before soman exposure (e.g., when the gas attack alarm is given) or at the same time as poisoning by soman, it is not expected to be effective and may exacerbate the effects of a sub-lethal exposure to soman. Do not take pyridostigmine bromide after exposure to soman.
Safety information
Side effects
Common side effects include diarrhea, abdominal pain, painful menstrual periods and muscle twitching. Serious side effects include difficulty breathing, severe dizziness and loss of consciousness. If any of these occur, temporarily stop taking pyridostigmine and seek immediate medical attention.
FDA boxed warning
Risks with improper use of pyridostigmine bromide
After Exposure to Soman, Use Atropine and Pralidoxime
Pyridostigmine bromide is for use as a pretreatment for exposure to soman nerve agent. Pyridostigmine bromide alone will not protect against exposure to soman. The efficacy of pyridostigmine bromide is dependent upon the rapid use of atropine and pralidoxime (2-PAM) after soman exposure.
Always Use Protective Garment(s)
Primary protection against exposure to chemical nerve agents is the wearing of protective garments including masks, hoods, and overgarments designed specifically for this use. Individuals must not rely solely upon pretreatment with pyridostigmine bromide and on the antidotes atropine and pralidoxime (2-PAM) to provide complete protection from poisoning by soman nerve agent.
Pyridostigmine Bromide as Pretreatment Only
If pyridostigmine bromide is taken immediately before exposure (e.g., when the gas attack alarm is given) or at the same time as poisoning by soman, it is not expected to be effective and may exacerbate the effects of a sub-lethal exposure to soman. Do not take pyridostigmine bromide after exposure to soman.
FOR MILITARY MEDICAL USE ONLY
If taken immediately before soman exposure (e.g., when the gas attack alarm is given) or at the same time as poisoning by soman, it is not expected to be effective and may exacerbate the effects of a sub-lethal exposure to soman. Do not take pyridostigmine bromide after exposure to soman.
A boxed warning is the strongest warning the US Food and Drug Administration requires on a medicine label. Text is taken from the official label, with internal section references removed.
When to call your doctor
If symptoms are severe or getting worse quickly, seek emergency care rather than waiting.
Before taking this medicine
Do not take Mestinon if you have a physical blockage in your intestines or urinary tract, or a known allergy to pyridostigmine or other anticholinesterase medicines. Use with caution if you have asthma, chronic obstructive pulmonary disease (COPD), a slow heartbeat, an abnormal heart rhythm or sensitivity to bromide, or if you take a beta blocker. Kidney impairment can increase the risk of side effects; your prescriber may need to monitor your kidney function and carefully select your treatment. If serious side effects occur, temporarily stop taking pyridostigmine and seek immediate medical attention. At the first sign of soman poisoning, pyridostigmine must be stopped and atropine and pralidoxime (2-PAM) must be given immediately.
Interactions
Tell your doctor if you use mefloquine, anticholinesterase medicines for glaucoma, narcotic pain medicines, or medicines converted to pantothenic acid, such as dexpanthenol. These can add to pyridostigmine’s effects; mefloquine may increase effects on the gut and heart rate, and narcotics may worsen a slow heartbeat. Also tell your doctor about aminoglycoside antibiotics, medicines for irregular heart rhythms, and any planned anaesthesia. Local anaesthetics, some general anaesthetics and other medicines that affect communication between nerves and muscles require caution. Pyridostigmine can increase the effects of depolarising muscle relaxants and may mean that non-depolarising muscle relaxants need adjustment by your doctor.
Using Mestinon
Dosing
Dosing is set by your prescriber. Each health care professional may prescribe medication differently according to a patient's medical history and condition, so follow the directions on your prescription label and speak to your doctor or pharmacist before changing anything.
Storage
Store below 25°C in a dry place, in the original pack, away from direct light and moisture. Do not keep it in a bathroom. Keep all medicines out of the sight and reach of children.
Detailed information for this medicine is being written by our pharmacy team. Pack sizes and pricing are shown alongside.
Clinical information on this page is summarised from the US FDA label PYRIDOSTIGMINE BROMIDE TABLET, EXTENDED RELEASE [AMNEAL PHARMACEUTICALS LLC] (DailyMed, retrieved 19 September 2026).
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