pyridostigmine ๐Ÿถ Veterinary Use | Indications/Contra | FAERs-F | FAERs-M | Orange Bk | BioActivity |

Stem definitionDrug idCAS RN
acetylcholinesterase inhibitors 2330 155-97-5

Description:

MoleculeDescription

Molfile Inchi Smiles

Synonyms:

  • pyridostigmine
  • pyridostigmine bromide
  • pyridostigmine iodide
A cholinesterase inhibitor with a slightly longer duration of action than NEOSTIGMINE. It is used in the treatment of myasthenia gravis and to reverse the actions of muscle relaxants.
  • Molecular weight: 181.21
  • Formula: C9H13N2O2
  • CLOGP: -4.26
  • LIPINSKI: 0
  • HAC: 4
  • HDO: 0
  • TPSA: 33.42
  • ALOGS: -2.32
  • ROTB: 2

  • Status: OFP

  • Legend:
    OFP - off patent
    OFM - off market
    ONP - on patent

Drug dosage:

DoseUnitRoute
0.18 g O
10 mg P

ADMET properties:

PropertyValueReference
BDDCS (Biopharmaceutical Drug Disposition Classification System) 3 Benet LZ, Broccatelli F, Oprea TI
S (Water solubility) 52 mg/mL Bocci G, Oprea TI, Benet LZ
EoM (Fraction excreted unchanged in urine) 85 % Benet LZ, Broccatelli F, Oprea TI
MRTD (Maximum Recommended Therapeutic Daily Dose) 76.59 ยตM/kg/day Contrera JF, Matthews EJ, Kruhlak NL, Benz RD
BA (Bioavailability) 7.60 % Kim MT, Sedykh A, Chakravarti SK, Saiakhov RD, Zhu H
Vd (Volume of distribution) 1.10 L/kg Lombardo F, Berellini G, Obach RS
CL (Clearance) 9.60 mL/min/kg Lombardo F, Berellini G, Obach RS
fu (Fraction unbound in plasma) 1 % Lombardo F, Berellini G, Obach RS
t_half (Half-life) 1.50 hours Lombardo F, Berellini G, Obach RS

Approvals:

DateAgencyCompanyOrphan
April 6, 1955 FDA VALEANT PHARMS LLC

FDA Adverse Event Reporting System (Female)

MedDRA adverse event termLikelihood ratioLikelihood ratio thresholdPatients taking drug having adverse eventPatients taking drug not having adverse eventPatients not taking drug having adverse eventPatients not taking drug not having adverse event
Myasthenia gravis 577.22 17.25 128 7146 4453 63477295
Myasthenia gravis crisis 356.13 17.25 60 7214 452 63481296
Diplopia 86.96 17.25 46 7228 23682 63458066
Eyelid ptosis 74.85 17.25 29 7245 7238 63474510
Thymoma 68.65 17.25 13 7261 200 63481548
Off label use 49.36 17.25 179 7095 674283 62807465
Dysphagia 44.88 17.25 53 7221 88532 63393216
Muscular weakness 44.36 17.25 62 7212 122291 63359457
Adiposis dolorosa 40.77 17.25 9 7265 304 63481444
Nocardiosis 39.89 17.25 13 7261 1963 63479785
Glucose tolerance impaired 36.75 17.25 17 7257 6560 63475188
Speech disorder 36.34 17.25 33 7241 40596 63441152
Oromandibular dystonia 36.11 17.25 9 7265 518 63481230
Diaphragmatic paralysis 34.60 17.25 9 7265 615 63481133
Cholinergic syndrome 31.29 17.25 8 7266 510 63481238
Myasthenic syndrome 31.25 17.25 7 7267 253 63481495
Bradycardia 29.38 17.25 39 7235 73188 63408560
Postural orthostatic tachycardia syndrome 28.14 17.25 9 7265 1280 63480468
Arteriospasm coronary 27.74 17.25 12 7262 3956 63477792
Product residue present 27.71 17.25 12 7262 3967 63477781
Product substitution issue 27.29 17.25 19 7255 15977 63465771
Borderline leprosy 27.01 17.25 4 7270 11 63481737
Acute on chronic liver failure 27 17.25 6 7268 209 63481539
Meningitis aseptic 25.50 17.25 12 7262 4811 63476937
Blood pressure increased 23.39 17.25 55 7219 162007 63319741
Sinoatrial block 22.72 17.25 7 7267 881 63480867
Gastric infection 22.61 17.25 10 7264 3477 63478271
Suspected COVID-19 22.11 17.25 9 7265 2553 63479195
Respiratory distress 21.79 17.25 23 7251 33928 63447820
Symptom recurrence 21.43 17.25 8 7266 1802 63479946
Supine hypertension 20.97 17.25 4 7270 64 63481684
Torticollis 20.86 17.25 8 7266 1941 63479807
Salivary hypersecretion 20.26 17.25 12 7262 7654 63474094
Transfusion-related circulatory overload 20.13 17.25 4 7270 80 63481668
Pulmonary nocardiosis 19.07 17.25 5 7269 352 63481396
Headache 18.60 17.25 130 7144 633111 62848637
Respiratory failure 18.58 17.25 38 7236 101820 63379928
COVID-19 18.09 17.25 40 7234 113063 63368685
Cerebral toxoplasmosis 18.00 17.25 6 7268 972 63480776
Asthenia 17.89 17.25 89 7185 383515 63098233
Dysarthria 17.51 17.25 23 7251 42688 63439060
Thermal burn 17.40 17.25 10 7264 6036 63475712

FDA Adverse Event Reporting System (Male)

MedDRA adverse event termLikelihood ratioLikelihood ratio thresholdPatients taking drug having adverse eventPatients taking drug not having adverse eventPatients not taking drug having adverse eventPatients not taking drug not having adverse event
Myasthenia gravis 251.87 17.40 75 4861 6865 34945130
Myasthenia gravis crisis 235.69 17.40 45 4891 582 34951413
Eyelid ptosis 148.73 17.40 48 4888 5718 34946277
Diplopia 92.84 17.40 46 4890 16797 34935198
Glucose tolerance impaired 48.25 17.40 18 4918 3286 34948709
Respiratory failure 44.48 17.40 65 4871 108507 34843488
Off label use 42.99 17.40 143 4793 419381 34532614
Myasthenic syndrome 39.02 17.40 10 4926 521 34951474
Product residue present 36.62 17.40 14 4922 2732 34949263
Muscular weakness 33.29 17.40 46 4890 72851 34879144
Ocular myasthenia 30.47 17.40 7 4929 229 34951766
Eye luxation 26.75 17.40 4 4932 9 34951986
Thymoma 25.73 17.40 5 4931 71 34951924
Meningitis aseptic 24.50 17.40 11 4925 3213 34948782
Cerebral toxoplasmosis 23.76 17.40 9 4927 1712 34950283
Ophthalmoplegia 23.17 17.40 9 4927 1831 34950164
Myiasis 22.46 17.40 4 4932 34 34951961
Myopathy 22.18 17.40 16 4920 11538 34940457
Lip swelling 21.56 17.40 18 4918 16062 34935933
Faecal vomiting 21.46 17.40 6 4930 436 34951559
Histoplasmosis 21.18 17.40 8 4928 1510 34950485
Lichenoid keratosis 20.48 17.40 9 4927 2499 34949496
Osteopenia 20.24 17.40 11 4925 4838 34947157
Cholinergic syndrome 19.78 17.40 6 4930 581 34951414
Throat tightness 19.39 17.40 13 4923 8345 34943650
Osteoporosis 18.70 17.40 15 4921 12653 34939342
Skin hyperpigmentation 18.22 17.40 9 4927 3255 34948740
Rash scarlatiniform 17.91 17.40 4 4932 115 34951880

FDA Adverse Event Reporting System (Geriatric)

MedDRA adverse event termLikelihood ratioLikelihood ratio thresholdPatients taking drug having adverse eventPatients taking drug not having adverse eventPatients not taking drug having adverse eventPatients not taking drug not having adverse event
Myasthenia gravis 623.49 14.26 164 10335 10235 79723654
Myasthenia gravis crisis 501.40 14.26 92 10407 1019 79732870
Eyelid ptosis 199.00 14.26 69 10430 10975 79722914
Diplopia 130.98 14.26 71 10428 33395 79700494
Thymoma 87.08 14.26 17 10482 267 79733622
Glucose tolerance impaired 84.89 14.26 34 10465 8050 79725839
Off label use 82.74 14.26 284 10215 906931 78826958
Myasthenic syndrome 63.68 14.26 16 10483 826 79733063
Muscular weakness 61.68 14.26 90 10409 160639 79573250
Respiratory failure 52.34 14.26 89 10410 180822 79553067
Cholinergic syndrome 50.32 14.26 14 10485 1073 79732816
Dysphagia 47.71 14.26 69 10430 122067 79611822
Cerebral toxoplasmosis 43.46 14.26 15 10484 2347 79731542
Meningitis aseptic 42.68 14.26 20 10479 6908 79726981
Adiposis dolorosa 39.52 14.26 9 10490 304 79733585
Ocular myasthenia 37.62 14.26 9 10490 378 79733511
Product residue present 34.13 14.26 14 10485 3522 79730367
Speech disorder 30.94 14.26 37 10462 54408 79679481
Nocardiosis 30.74 14.26 15 10484 5664 79728225
Ophthalmoplegia 29.71 14.26 12 10487 2900 79730989
Salivary hypersecretion 29.26 14.26 20 10479 14204 79719685
Suspected COVID-19 28.86 14.26 12 10487 3121 79730768
Oromandibular dystonia 28.66 14.26 9 10490 1049 79732840
Diaphragmatic paralysis 28.22 14.26 9 10490 1103 79732786
Osteopenia 26.83 14.26 21 10478 18343 79715546
Pulmonary nocardiosis 26.76 14.26 9 10490 1302 79732587
Eye luxation 26.20 14.26 4 10495 12 79733877
Acute on chronic liver failure 23.78 14.26 6 10493 315 79733574
Bradycardia 23.70 14.26 54 10445 135503 79598386
Borderline leprosy 23.69 14.26 4 10495 26 79733863
Gastric infection 23.63 14.26 11 10488 3742 79730147
Dysarthria 23.24 14.26 36 10463 67586 79666303
Respiratory distress 22.82 14.26 33 10466 58306 79675583
Blood pressure increased 22.49 14.26 70 10429 211290 79522599
Myiasis 22.44 14.26 4 10495 37 79733852
Symptom recurrence 21.78 14.26 9 10490 2305 79731584
COVID-19 19.40 14.26 55 10444 157619 79576270
Product substitution issue 19.05 14.26 18 10481 20238 79713651
Respiratory acidosis 18.99 14.26 14 10485 11186 79722703
Sinoatrial block 18.89 14.26 7 10492 1344 79732545
Torticollis 18.21 14.26 8 10491 2379 79731510
Asthenia 17.96 14.26 122 10377 511567 79222322
Lymphopenia 17.74 14.26 21 10478 30536 79703353
Postural orthostatic tachycardia syndrome 17.41 14.26 6 10493 934 79732955
Sensory disturbance 17.33 14.26 15 10484 15062 79718827
Thermal burn 16.97 14.26 11 10488 7149 79726740
Lichenoid keratosis 16.96 14.26 9 10490 4048 79729841
Faecal vomiting 16.36 14.26 6 10493 1118 79732771
Menopause 15.89 14.26 7 10492 2095 79731794
Drug ineffective for unapproved indication 15.84 14.26 26 10473 51212 79682677
Myopathy 15.14 14.26 16 10483 20547 79713342
Histoplasmosis 15.10 14.26 7 10492 2358 79731531
Bulbar palsy 14.87 14.26 4 10495 270 79733619
Muscle contractions involuntary 14.75 14.26 8 10491 3757 79730132
Diabetes mellitus 14.55 14.26 32 10467 78358 79655531
Arthritis bacterial 14.52 14.26 11 10488 9155 79724734
Cartilage injury 14.52 14.26 6 10493 1537 79732352
Restrictive pulmonary disease 14.48 14.26 7 10492 2588 79731301
Rebound effect 14.48 14.26 10 10489 7216 79726673
Skin hyperpigmentation 14.38 14.26 10 10489 7293 79726596

FDA Adverse Event Reporting System (Pediatric)

None

Pharmacologic Action:

SourceCodeDescription
ATC N07AA02 NERVOUS SYSTEM
OTHER NERVOUS SYSTEM DRUGS
PARASYMPATHOMIMETICS
Anticholinesterases
FDA MoA N0000000177 Cholinesterase Inhibitors
MeSH PA D018678 Cholinergic Agents
MeSH PA D002800 Cholinesterase Inhibitors
MeSH PA D004791 Enzyme Inhibitors
MeSH PA D018377 Neurotransmitter Agents
FDA EPC N0000175723 Cholinesterase Inhibitor

Drug Use | Suggest Off label Use Form| |View source of the data|

DiseaseRelationSNOMED_IDDOID
Myasthenia gravis indication 91637004 DOID:437
Neuromuscular Block due to Nondepolarizing Drug indication
Prevention of Nerve Agent Poisoning indication
Urinary tract obstruction contraindication 7163005 DOID:5200
Kidney disease contraindication 90708001 DOID:557
Gastrointestinal obstruction contraindication 126765001
Asthma contraindication 195967001 DOID:2841




๐Ÿถ Veterinary Drug Use

None

๐Ÿถ Veterinary products

None

Acid dissociation constants calculated using MoKa v3.0.0

None

Orange Book patent data (new drug applications)

None

Orange Book exclusivity data (new drug applications)

None

Bioactivity Summary:

TargetClassPharosUniProtActionTypeActivity value
(-log[M])
Mechanism
action
Bioact sourceMoA source
Acetylcholinesterase Enzyme INHIBITOR IC50 6.44 CHEMBL CHEMBL
Cholinesterase Enzyme Ki 5.46 CHEMBL
Acetylcholinesterase Enzyme IC50 7.09 CHEMBL
Acetylcholinesterase Enzyme Ki 4.71 CHEMBL

External reference:

IDSource
4019921 VUID
N0000148006 NUI
D00487 KEGG_DRUG
101-26-8 SECONDARY_CAS_RN
4017783 VANDF
4019921 VANDF
C0034261 UMLSCUI
CHEBI:8665 CHEBI
CHEMBL1115 ChEMBL_ID
DB00545 DRUGBANK_ID
CHEMBL812 ChEMBL_ID
D011729 MESH_DESCRIPTOR_UI
4991 PUBCHEM_CID
8994 IUPHAR_LIGAND_ID
4685-03-4 SECONDARY_CAS_RN
19QM69HH21 UNII
9000 RXNORM
46043 MMSL
5392 MMSL
d00363 MMSL
001707 NDDF
004687 NDDF
34915005 SNOMEDCT_US
373344003 SNOMEDCT_US
59953007 SNOMEDCT_US
278 INN_ID

Pharmaceutical products:

ProductCategoryIngredientsNDCFormQuantityRouteMarketingLabel
Pyridostigmine Bromide HUMAN PRESCRIPTION DRUG LABEL 1 0115-1404 TABLET, EXTENDED RELEASE 180 mg ORAL ANDA 12 sections
Pyridostigmine Bromide HUMAN PRESCRIPTION DRUG LABEL 1 0115-2134 TABLET 30 mg ORAL ANDA 11 sections
Pyridostigmine Bromide HUMAN PRESCRIPTION DRUG LABEL 1 0115-3511 TABLET 60 mg ORAL ANDA 12 sections
Pyridostigmine Bromide HUMAN PRESCRIPTION DRUG LABEL 1 0115-3511 TABLET 60 mg ORAL ANDA 12 sections
Mestinon HUMAN PRESCRIPTION DRUG LABEL 1 0187-3010 TABLET 60 mg ORAL NDA 15 sections
Mestinon HUMAN PRESCRIPTION DRUG LABEL 1 0187-3010 TABLET 60 mg ORAL NDA 15 sections
Mestinon HUMAN PRESCRIPTION DRUG LABEL 1 0187-3012 SOLUTION 60 mg ORAL NDA 15 sections
Mestinon HUMAN PRESCRIPTION DRUG LABEL 1 0187-3012 SOLUTION 60 mg ORAL NDA 15 sections
Mestinon HUMAN PRESCRIPTION DRUG LABEL 1 0187-3013 TABLET, EXTENDED RELEASE 180 mg ORAL NDA 15 sections
Mestinon HUMAN PRESCRIPTION DRUG LABEL 1 0187-3013 TABLET, EXTENDED RELEASE 180 mg ORAL NDA 15 sections
Regonol HUMAN PRESCRIPTION DRUG LABEL 1 0781-3040 INJECTION, SOLUTION 5 mg INTRAVENOUS NDA 19 sections
Regonol HUMAN PRESCRIPTION DRUG LABEL 1 0781-3040 INJECTION, SOLUTION 5 mg INTRAVENOUS NDA 19 sections
pyridostigmine bromide HUMAN PRESCRIPTION DRUG LABEL 1 0904-6622 TABLET 60 mg ORAL ANDA 11 sections
Pryidostigmine Bromide HUMAN PRESCRIPTION DRUG LABEL 1 16571-833 SOLUTION 60 mg ORAL ANDA 11 sections
PRYIDOSTIGMINE BROMIDE HUMAN PRESCRIPTION DRUG LABEL 1 24689-104 SOLUTION 60 mg ORAL ANDA 14 sections
Pyridostigmine Bromide HUMAN PRESCRIPTION DRUG LABEL 1 47781-335 TABLET, EXTENDED RELEASE 180 mg ORAL ANDA 12 sections
Pyridostigmine Bromide HUMAN PRESCRIPTION DRUG LABEL 1 47781-335 TABLET, EXTENDED RELEASE 180 mg ORAL ANDA 12 sections
Pyridostigmine Bromide HUMAN PRESCRIPTION DRUG LABEL 1 58657-810 TABLET 30 mg ORAL ANDA 13 sections
Pyridostigmine Bromide HUMAN PRESCRIPTION DRUG LABEL 1 58657-810 TABLET 30 mg ORAL ANDA 13 sections
Pyridostigmine Bromide HUMAN PRESCRIPTION DRUG LABEL 1 60687-502 TABLET 60 mg ORAL ANDA 12 sections
Pyridostigmine Bromide HUMAN PRESCRIPTION DRUG LABEL 1 60687-502 TABLET 60 mg ORAL ANDA 12 sections
Pyridostigmine Bromide Human Prescription Drug Label 1 63739-969 TABLET 60 mg ORAL ANDA 11 sections
Pyridostigmine Bromide Human Prescription Drug Label 1 64980-220 TABLET 180 mg ORAL ANDA 9 sections
Pyridostigmine Bromide Human Prescription Drug Label 1 64980-220 TABLET 180 mg ORAL ANDA 9 sections
pyridostigmine bromide HUMAN PRESCRIPTION DRUG LABEL 1 65841-819 TABLET 60 mg ORAL ANDA 11 sections
pyridostigmine bromide HUMAN PRESCRIPTION DRUG LABEL 1 65841-819 TABLET 60 mg ORAL ANDA 11 sections
Pyridostigmine Bromide HUMAN PRESCRIPTION DRUG LABEL 1 66689-406 SOLUTION 60 mg ORAL ANDA 12 sections
Pyridostigmine Bromide HUMAN PRESCRIPTION DRUG LABEL 1 66689-406 SOLUTION 60 mg ORAL ANDA 12 sections
Pyridostigmine Bromide HUMAN PRESCRIPTION DRUG LABEL 1 68071-5032 TABLET, EXTENDED RELEASE 180 mg ORAL ANDA 12 sections
Pyridostigmine Bromide HUMAN PRESCRIPTION DRUG LABEL 1 68084-494 TABLET 60 mg ORAL ANDA 15 sections