Pyridostigmine Shortage Update: What Patients Need to Know in 2026

If you take Pyridostigmine (brand name Mestinon) for myasthenia gravis, POTS, or another condition, supply problems with the 180 mg extended-release tablets have been disrupting patients' lives since 2024. In this update, we'll cover where things stand in 2026, what's driving the shortage, and what concrete steps you can take to protect your supply.

What's the Current Status of the Pyridostigmine Shortage in 2026?

The short answer: availability depends heavily on which formulation you need.

Pyridostigmine ER 180 mg (generic): Remains difficult to find at many pharmacies. Generic manufacturers Alvogen and Rising Pharmaceuticals reported back orders beginning in 2024, with no firm resolution timeline.

Brand-name Mestinon Timespan 180 mg (Bausch Health): More consistently available, but expensive — retail price can exceed $800 for a 30-day supply without insurance.

Pyridostigmine IR 60 mg (generic): Generally available. Cash price runs $75–$125 for 90 tablets; with GoodRx or SingleCare discount cards, as low as $25–$35.

Oral solution (60 mg/5 mL syrup): Available but may need to be special-ordered at some pharmacies.

Has the FDA Declared a Formal Shortage?

As of early 2026, Pyridostigmine Bromide is not listed on the FDA's official Drug Shortage Database. This is surprising given the widespread patient reports of difficulty filling prescriptions for the ER formulation. Without a formal listing, there's no coordinated government response or mandated production increase.

Patients who continue experiencing difficulty finding their medication can report supply problems directly to the FDA at drugshortages@fda.hhs.gov. Patient reports can help trigger FDA engagement with manufacturers.

Who Is Most Affected?

Patients with myasthenia gravis who take the 180 mg ER tablets are most impacted. Many prefer this formulation because it provides stable, extended symptom control with fewer daily doses — important for a disease where muscle weakness can progress rapidly if medication levels drop.

Patients with POTS who use Pyridostigmine off-label are also affected. Demand has grown as POTS awareness — especially post-COVID — has increased, putting additional pressure on existing supply.

What's Driving the Shortage?

Several structural issues converge to make Pyridostigmine ER supply vulnerable:

Limited manufacturer base: Only a small number of generic makers produce the ER formulation. When one goes on back order, there is no backup.

Complex manufacturing: The wax-matrix extended-release technology is more sensitive to production variability than simple tablets.

Small patient population: Myasthenia gravis affects an estimated 36,000–60,000 Americans — a small market that attracts fewer manufacturers and investment.

Global API sourcing: Active ingredient sourced overseas means international supply chain disruptions can ripple through to U.S. shelves months later.

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How Much Does Pyridostigmine Cost in 2026?

Cost varies significantly by formulation and whether you use insurance or a discount card:

Generic Pyridostigmine IR 60 mg (90 tablets): $26–$50 with GoodRx or SingleCare; ~$75–$125 retail

Generic Pyridostigmine ER 180 mg (30 tablets): $80–$150 with a discount card; $490–$750 retail

Brand-name Mestinon Timespan 180 mg: $800+ without insurance

What Can Patients Do Right Now?

Refill early: Don't wait until you're out. Most insurance plans allow refills 7–10 days before your supply runs out.

Call independent pharmacies: They often use different wholesalers than chain pharmacies and may have stock when the big chains don't.

Ask about partial fills to bridge the gap while you wait for a full supply.

Use medfinder.com to have pharmacies near you checked for your specific formulation, so you don't have to spend hours calling.

Talk to your neurologist about temporarily switching to the IR formulation if the ER remains unavailable.

Skip the calls, skip the stress.

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The Bottom Line

The Pyridostigmine shortage in 2026 is real, especially for the ER 180 mg formulation, but there are practical steps you can take to manage it. Act early, be persistent, and work with your healthcare team. For a step-by-step guide on locating your medication, see how to find Pyridostigmine in stock near you.