pyridostigmine 🐶 Veterinary Use | Indications/Contra | FAERs-F | FAERs-M | Orange Bk | BioActivity |

Stem definition	Drug id	CAS RN
acetylcholinesterase inhibitors	2330	155-97-5

Description:

Molecule	Description
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

Molecule

Description

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:

Dose	Unit	Route
0.18	g	O
10	mg	P

ADMET properties:

Property	Value	Reference
BDDCS (Biopharmaceutical Drug Disposition Classification System)	3	Benet LZ, Broccatelli F, Oprea TI
S (Water solubility)	100 mg/mL	Benet LZ, Broccatelli F, Oprea TI
EoM (Fraction excreted unchanged in urine)	85 %	Benet LZ, Broccatelli F, Oprea TI
MRTD (Maximum Recommended Therapeutic Daily Dose)	76.59 µM/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:

Date	Agency	Company	Orphan
April 6, 1955	FDA	VALEANT PHARMS LLC

FDA Adverse Event Reporting System (Female)

MedDRA adverse event term	Likelihood ratio	Likelihood ratio threshold	Patients taking drug having adverse event	Patients taking drug not having adverse event	Patients not taking drug having adverse event	Patients not taking drug not having adverse event
Myasthenia gravis	445.22	16.81	98	5438	3454	50596134
Myasthenia gravis crisis	289.73	16.81	48	5488	340	50599248
Diplopia	68.39	16.81	36	5500	19224	50580364
Eyelid ptosis	62.37	16.81	24	5512	6163	50593425
Muscular weakness	43.90	16.81	53	5483	94960	50504628
Dysphagia	42.10	16.81	47	5489	77471	50522117
Adiposis dolorosa	36.59	16.81	8	5528	271	50599317
Cholinergic syndrome	34.08	16.81	8	5528	374	50599214
Myasthenic syndrome	33.33	16.81	7	5529	195	50599393
Thymoma	33.12	16.81	6	5530	75	50599513
Diaphragmatic paralysis	30.97	16.81	8	5528	557	50599031
Product residue present	29.18	16.81	12	5524	3660	50595928
Acute on chronic liver failure	27.98	16.81	6	5530	185	50599403
Blood pressure increased	27.60	16.81	51	5485	133081	50466507
Intentional product use issue	24.81	16.81	36	5500	76882	50522706
Meningitis aseptic	24.52	16.81	11	5525	4141	50595447
Sinoatrial block	23.98	16.81	7	5529	768	50598820
Headache	22.52	16.81	112	5424	506423	50093165
Salivary hypersecretion	22.48	16.81	12	5524	6579	50593009
Speech disorder	21.80	16.81	23	5513	35525	50564063
Gastric infection	21.16	16.81	9	5527	2983	50596605
Supine hypertension	21.16	16.81	4	5532	64	50599524
Transfusion-related circulatory overload	20.99	16.81	4	5532	67	50599521
COVID-19	19.86	16.81	25	5511	46637	50552951
Cartilage injury	18.82	16.81	7	5529	1635	50597953
Product substitution issue	18.47	16.81	14	5522	14043	50585545
Asthenia	17.42	16.81	75	5461	318967	50280621
Respiratory distress	17.42	16.81	19	5517	30470	50569118
Off label use	17.04	16.81	99	5437	474327	50125261
Thermal burn	17.03	16.81	9	5527	4832	50594756
Drooling	16.96	16.81	8	5528	3376	50596212

FDA Adverse Event Reporting System (Male)

MedDRA adverse event term	Likelihood ratio	Likelihood ratio threshold	Patients taking drug having adverse event	Patients taking drug not having adverse event	Patients not taking drug having adverse event	Patients not taking drug not having adverse event
Myasthenia gravis	246.77	17.50	62	3996	3089	29567380
Myasthenia gravis crisis	202.98	17.50	38	4020	453	29570016
Eyelid ptosis	90.62	17.50	32	4026	5154	29565315
Diplopia	75.75	17.50	37	4021	13481	29556988
Respiratory failure	40.87	17.50	58	4000	97073	29473396
Product residue present	38.08	17.50	14	4044	2525	29567944
Myasthenic syndrome	31.78	17.50	8	4050	399	29570070
Ocular myasthenia	30.97	17.50	7	4051	219	29570250
Off label use	29.31	17.50	99	3959	300701	29269768
Eye luxation	27.53	17.50	4	4054	7	29570462
Thymoma	27.14	17.50	5	4053	54	29570415
Cerebral toxoplasmosis	25.72	17.50	9	4049	1407	29569062
Myiasis	24.09	17.50	4	4054	22	29570447
Histoplasmosis	22.28	17.50	8	4050	1348	29569121
Faecal vomiting	22.26	17.50	6	4052	392	29570077
Lichenoid keratosis	21.99	17.50	9	4049	2161	29568308
Lip swelling	21.57	17.50	16	4042	12394	29558075
Myopathy	21.56	17.50	15	4043	10518	29559951
Meningitis aseptic	21.20	17.50	9	4049	2367	29568102
Cholinergic syndrome	21.07	17.50	6	4052	480	29569989
Ophthalmoplegia	20.60	17.50	8	4050	1674	29568795
Muscular weakness	20.30	17.50	33	4025	62019	29508450
Skin hyperpigmentation	19.58	17.50	9	4049	2855	29567614
Rebound effect	19.14	17.50	8	4050	2023	29568446
Throat tightness	19.14	17.50	12	4046	7079	29563390
Rash scarlatiniform	18.06	17.50	4	4054	114	29570355
Intestinal perforation	17.70	17.50	12	4046	8074	29562395

FDA Adverse Event Reporting System (Geriatric)

MedDRA adverse event term	Likelihood ratio	Likelihood ratio threshold	Patients taking drug having adverse event	Patients taking drug not having adverse event	Patients not taking drug having adverse event	Patients not taking drug not having adverse event
Myasthenia gravis	538.68	15.79	129	8177	5609	64484817
Myasthenia gravis crisis	412.24	15.79	75	8231	809	64489617
Eyelid ptosis	136.76	15.79	50	8256	9475	64480951
Diplopia	100.95	15.79	55	8251	26710	64463716
Myasthenic syndrome	57.88	15.79	14	8292	631	64489795
Cholinergic syndrome	54.15	15.79	14	8292	829	64489597
Thymoma	52.32	15.79	10	8296	143	64490283
Muscular weakness	51.11	15.79	72	8234	127266	64363160
Respiratory failure	47.55	15.79	79	8227	161104	64329322
Cerebral toxoplasmosis	43.46	15.79	14	8292	1812	64488614
Dysphagia	42.26	15.79	60	8246	106752	64383674
Off label use	39.24	15.79	173	8133	632633	63857793
Ocular myasthenia	38.08	15.79	9	8297	367	64490059
Meningitis aseptic	37.09	15.79	17	8289	5713	64484713
Product residue present	35.60	15.79	14	8292	3228	64487198
Adiposis dolorosa	35.29	15.79	8	8298	271	64490155
Salivary hypersecretion	32.60	15.79	20	8286	12093	64478333
Ophthalmoplegia	27.34	15.79	11	8295	2691	64487735
Eye luxation	26.82	15.79	4	8302	10	64490416
Diaphragmatic paralysis	24.90	15.79	8	8298	1026	64489400
Acute on chronic liver failure	24.50	15.79	6	8300	285	64490141
Myiasis	23.91	15.79	4	8302	25	64490401
Gastric infection	22.17	15.79	10	8296	3238	64487188
Blood pressure increased	21.91	15.79	60	8246	172492	64317934
Dysarthria	21.48	15.79	32	8274	59374	64431052
Sinoatrial block	20.05	15.79	7	8299	1159	64489267
COVID-19	19.27	15.79	32	8274	65108	64425318
Lichenoid keratosis	18.82	15.79	9	8297	3325	64487101
Respiratory distress	18.65	15.79	28	8278	52303	64438123
Toxicity to various agents	18.55	15.79	12	8294	363501	64126925
Asthenia	17.94	15.79	105	8201	427939	64062487
Myopathy	17.49	15.79	16	8290	17664	64472762
Speech disorder	17.38	15.79	26	8280	48415	64442011
Sensory disturbance	17.22	15.79	14	8292	13194	64477232
Faecal vomiting	17.03	15.79	6	8300	1019	64489407
Thermal burn	16.53	15.79	10	8296	5896	64484530
Histoplasmosis	16.30	15.79	7	8299	2015	64488411
Respiratory acidosis	16.24	15.79	12	8294	9843	64480583
Restrictive pulmonary disease	15.82	15.79	7	8299	2165	64488261

FDA Adverse Event Reporting System (Pediatric)

None

Pharmacologic Action:

Source	Code	Description
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|

Disease	Relation	SNOMED_ID	DOID
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

🐶 Veterinary Drug Use

None

🐶 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:

Target	Class	Pharos	UniProt	Action	Type	Activity value (-log[M])	Bioact source	MoA source
Acetylcholinesterase	Enzyme	P22303	ACES_HUMAN	INHIBITOR	IC50	6.44	CHEMBL	CHEMBL
Cholinesterase	Enzyme	P06276	CHLE_HUMAN		Ki	5.46	CHEMBL
Acetylcholinesterase	Enzyme		ACES_TORCA		IC50	7.09	CHEMBL
Acetylcholinesterase	Enzyme		ACES_BOVIN		Ki	4.71	CHEMBL

External reference:

ID	Source
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:

Product	Category	Ingredients	NDC	Form	Quantity	Route	Marketing	Label
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	0115-3511	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	0187-3012	SOLUTION	60 mg	ORAL	NDA	15 sections
Mestinon	HUMAN PRESCRIPTION DRUG LABEL	1	0187-3013	TABLET, EXTENDED RELEASE	180 mg	ORAL	NDA	15 sections
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	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	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	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	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	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
pyridostigmine bromide	HUMAN PRESCRIPTION DRUG LABEL	1	68382-659	TABLET	60 mg	ORAL	ANDA	11 sections
pyridostigmine bromide	HUMAN PRESCRIPTION DRUG LABEL	1	68682-301	TABLET, EXTENDED RELEASE	180 mg	ORAL	NDA authorized generic	12 sections
Pyridostigmine Bromide	HUMAN PRESCRIPTION DRUG LABEL	1	68682-302	TABLET	60 mg	ORAL	NDA authorized generic	12 sections
pyridostigmine bromide	HUMAN PRESCRIPTION DRUG LABEL	1	68682-307	SOLUTION	60 mg	ORAL	NDA authorized generic	15 sections
Pyridostigmine Bromide	HUMAN PRESCRIPTION DRUG LABEL	1	69238-1731	SOLUTION	60 mg	ORAL	ANDA	11 sections
Pyridostigmine Bromide	HUMAN PRESCRIPTION DRUG LABEL	1	69784-130	SOLUTION	60 mg	ORAL	ANDA	14 sections
Pyridostigmine	Human Prescription Drug Label	1	70954-148	SOLUTION	60 mg	ORAL	ANDA	13 sections
Pyridostigmine Bromide	Human Prescription Drug Label	1	71930-028	TABLET	60 mg	ORAL	ANDA	11 sections
Pyridostigmine Bromide	HUMAN PRESCRIPTION DRUG LABEL	1	72458-128	TABLET	30 mg	ORAL	NDA	33 sections
Pryidostigmine Bromide	HUMAN PRESCRIPTION DRUG LABEL	1	73152-028	SOLUTION	60 mg	ORAL	ANDA	11 sections