Switching between neostigmine and pyridostigmine in myasthenia gravis

25 October 2022Switching between neostigmine and pyridostigmine requires care and application of a stepped process
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Medicine Compliance Aid Stability

MestinonMeda Pharmaceuticals

Meda Pharmaceuticals
Tablets 60mg
R1 · Red 1Stability data indicates that the drug is not suitable for CAs.
Hygroscopic, extended release tablets which are supplied with a dessicant.
1 November 2022

Lactation Safety Information

Very limited published evidence of safety
Negligible levels anticipated in milk due to the drug’s properties
3 August 2020

New Medicines

Myasthenia gravis and paralytic ileus - oral solution formulation


New formulation
Not Known

Development and Regulatory status

June 2022
Jun 22Viatris launches pyridostigmine 12mg/ml oral solution in the UK. NHS list price, £90 per 150ml [3,4].
Apr 19MHRA approves pyridostigmine 12mg/ml oral solution for treatment of adults and children with myasthenia gravis and treatment of adults with paralytic ileus. The approval was using the decentralised procedure. The oral solution is considered by the MHRA to be interchangeable with the reference product, Mestinon 60mg tablets [2].


An anticholinesterase. As an antagonist to cholinesterase, the enzyme which normally destroys acetylcholine, the action of pyridostigmine bromide to potentiate naturally occurring acetylcholine and so enhance neuromuscular transmission in voluntary and involuntary muscles. Available as a 12mg/ml sugar-free oral solution, to be used within 28 days of opening. Store below 25°C.
The incidence ranges from 0.3 to 2.8 per 100,000. It is estimated to affect more than 700,000 people worldwide, with prevalence of MG in the UK estimated at about 15 per 100,000 population. Peak incidence is in the third decade for women and the sixth or seventh decade in men [1].
Myasthenia gravis and paralytic ileus - oral solution formulation

Evidence based evaluations