Struggling to find Mestinon at your pharmacy? Learn why Pyridostigmine is hard to find in 2026, what's causing the shortage, and what you can do about it.
You've been taking Mestinon (Pyridostigmine Bromide) to manage your myasthenia gravis — or maybe your doctor recently prescribed it for POTS or another condition. You head to the pharmacy, only to hear the dreaded words: "We don't have it in stock."
If this has happened to you, you're far from alone. Thousands of patients across the country have been struggling to fill their Mestinon prescriptions, especially the extended-release (ER) 180 mg tablets. In this post, we'll explain what's going on, why it's happening, and — most importantly — what you can do about it.
Mestinon is the brand name for Pyridostigmine Bromide, a cholinesterase inhibitor made by Bausch Health. It works by slowing down the breakdown of acetylcholine, a chemical messenger that helps your nerves communicate with your muscles. By keeping more acetylcholine available at the neuromuscular junction, Mestinon helps improve muscle strength.
Mestinon is FDA-approved for the treatment of myasthenia gravis, a chronic autoimmune condition that causes muscle weakness. It's also increasingly used off-label for conditions like postural orthostatic tachycardia syndrome (POTS), neurogenic orthostatic hypotension, and Long COVID-related autonomic dysfunction.
It comes in three forms:
There are several reasons Mestinon — especially the generic extended-release formulation — has become difficult to find. Here are the main factors:
The generic ER formulation has faced ongoing supply disruptions. As of early 2025, two major generic manufacturers — Alvogen and Rising Pharmaceuticals — had Pyridostigmine ER 180 mg on back order with no estimated release date. When only one or two companies make a particular formulation and one halts production, the remaining supply gets stretched thin fast.
Mestinon was once prescribed primarily for myasthenia gravis, a relatively rare condition. But in recent years, doctors have increasingly prescribed it off-label for POTS, Long COVID, and chronic fatigue syndrome (ME/CFS). This surge in demand has put additional pressure on an already limited supply.
Unlike widely-used medications that have dozens of generic manufacturers, Pyridostigmine — especially the ER form — is made by only a handful of companies. This makes the supply chain fragile. When even one manufacturer experiences a disruption, pharmacies across the country feel the impact.
Even when Mestinon is technically available from a manufacturer, it doesn't always make it to your local pharmacy. Large chain pharmacies often rely on centralized distribution systems, and smaller or less common medications can get deprioritized. Independent pharmacies sometimes have access to different wholesalers and may have better luck sourcing the drug.
Finding your medication shouldn't feel like a treasure hunt, but here are practical steps that can help:
Medfinder lets you search for Mestinon availability at pharmacies near you in real time. Instead of calling pharmacy after pharmacy, you can see which locations actually have it in stock right now.
Independent and compounding pharmacies often use different drug wholesalers than big chains like CVS or Walgreens. They may have access to supply that chain pharmacies don't. It's worth calling a few local independents to check.
If you're having trouble finding the 180 mg extended-release tablets, talk to your doctor about switching to the 60 mg immediate-release tablets. The IR version is generally easier to find and more widely stocked, though you'll need to take it more frequently throughout the day.
Some patients have had success using mail-order pharmacies, which source medications from larger distribution networks. Your insurance plan may even offer lower copays for mail-order prescriptions.
If Mestinon is truly unavailable and you need treatment, your doctor may be able to prescribe an alternative medication. Options include Neostigmine (Prostigmin) or, for myasthenia gravis patients, immunosuppressant therapies like Azathioprine (Imuran).
The Mestinon shortage has been frustrating for patients who depend on this medication every day. The good news is that options exist — from switching formulations to using tools like Medfinder to track down available stock.
If you're a provider looking for ways to help your patients navigate this shortage, check out our provider's guide to finding Mestinon in stock.
Stay informed, stay proactive, and don't give up. Your health matters, and there are ways to get the medication you need.
You focus on staying healthy. We'll handle the rest.
Try Medfinder Concierge FreeMedfinder's mission is to ensure every patient gets access to the medications they need. We believe this begins with trustworthy information. Our core values guide everything we do, including the standards that shape the accuracy, transparency, and quality of our content. We’re committed to delivering information that’s evidence-based, regularly updated, and easy to understand. For more details on our editorial process, see here.
%2C%20Color%3DOriginal.png)
