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) 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 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 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 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 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 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 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:

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 0115-3511 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