Mestinon Is a Cholinesterase Inhibitor Used to Treat Myasthenia Gravis

Mestinon (Pyridostigmine Bromide) is a prescription medication that improves muscle strength by preventing the breakdown of acetylcholine, a chemical messenger essential for muscle contraction. It's one of the most widely prescribed treatments for myasthenia gravis and is also used off-label for several other conditions.

Whether you've just been prescribed Mestinon or you're researching it for the first time, this guide covers everything you need to know — from how it works to how much it costs.

What Is Mestinon?

Here are the key facts:

• Brand name: Mestinon, Mestinon Timespan (extended-release)
• Generic name: Pyridostigmine Bromide
• Drug class: Cholinesterase inhibitor (acetylcholinesterase inhibitor)
• Manufacturer: Bausch Health (formerly Valeant Pharmaceuticals)
• Generic available: Yes
• Controlled substance: No — Mestinon is not a controlled substance and does not have a DEA schedule

Mestinon has been used for decades and has a well-established safety profile. It's available as immediate-release tablets, extended-release tablets, and an oral syrup. To understand its pharmacology in more detail, see our article on how Mestinon works.

What Is Mestinon Used For?

FDA-Approved Uses

• Myasthenia gravis (MG) — This is the primary reason Mestinon is prescribed. MG is an autoimmune disorder where antibodies attack the connection between nerves and muscles, causing weakness. Mestinon helps by increasing acetylcholine availability at the neuromuscular junction, temporarily improving muscle strength.
• Reversal of neuromuscular blockade — The injectable form (Regonol) is used in hospitals to reverse the effects of muscle relaxants after surgery.
• Military nerve agent pretreatment — Pyridostigmine is used by the military as a pretreatment for exposure to the nerve agent soman.

Off-Label Uses

Mestinon is increasingly prescribed for conditions beyond myasthenia gravis:

• POTS (postural orthostatic tachycardia syndrome) — Mestinon can help stabilize heart rate and blood pressure when standing.
• Neurogenic orthostatic hypotension — For blood pressure drops caused by autonomic nerve damage.
• Long COVID autonomic dysfunction — Some patients with post-COVID dysautonomia have found relief with Pyridostigmine.
• Chronic fatigue syndrome (ME/CFS) — Used to address autonomic symptoms.
• Ehlers-Danlos syndrome (EDS) — For patients with autonomic dysfunction.

How Is Mestinon Taken?

Mestinon comes in three forms:

1. Immediate-release tablets (60 mg) — Taken every 3–6 hours as needed. Most patients take 60–360 mg per day in divided doses, though some may need up to 1,500 mg daily.
2. Extended-release tablets (Mestinon Timespan, 180 mg) — Taken once or twice daily. Often used at bedtime for overnight symptom control. Must be swallowed whole — do not crush or chew.
3. Oral syrup (60 mg per 5 mL) — Available for patients who have difficulty swallowing tablets.

Important dosing tips:

• Take with food or milk to reduce stomach upset
• Dosing is highly individualized — your doctor will adjust based on your symptoms
• Don't skip doses or double up if you miss one. Take the next dose as scheduled.
• Keep a consistent schedule for the best symptom control

Who Should Not Take Mestinon?

Mestinon is not right for everyone. You should not take it if you have:

• Mechanical intestinal obstruction — A physical blockage in your intestines
• Mechanical urinary tract obstruction — A physical blockage in your urinary system
• Known allergy to Pyridostigmine Bromide or any ingredients in the formulation
• Peritonitis — Inflammation of the tissue lining the abdomen

Tell your doctor about all medications you take before starting Mestinon. It has important drug interactions with corticosteroids, certain antibiotics, and other medications.

How Much Does Mestinon Cost?

The cost of Mestinon depends on the formulation and whether you use insurance or a discount card:

• Generic IR (60 mg, 90 tablets): $26–$50 with a discount card; $50–$150 without
• Generic ER (180 mg, 30 tablets): $105–$150 with a discount card; $700–$750 without

Most insurance plans cover generic Pyridostigmine. Brand-name Mestinon may require prior authorization. Medicare Part D typically covers the generic.

If cost is a concern, check out our complete guide to saving money on Mestinon, which covers discount cards, patient assistance programs, and other options.

Bausch Health offers a Patient Assistance Program for qualifying patients who are uninsured or underinsured. You can find details at bauschhealthpap.com or through NeedyMeds.

Final Thoughts

Mestinon is a proven, well-established medication that has been helping patients with myasthenia gravis for decades. Its growing use for POTS, Long COVID, and other autonomic conditions means more people than ever are learning about this drug.

If you've been prescribed Mestinon and need to find it in stock, Medfinder can help you locate a pharmacy near you. And for a deeper understanding of the medication, read about side effects to expect and how Mestinon works in your body.