Products Affected - Description

Pyridostigmine bromide injection

Reason for the Shortage

• Sandoz could not provide a reason for the shortage.
• There are no other manufacturers of pyridostigmine injection.
  

Available Products

Regonol injection, Sandoz¹
5 mg/mL, 2 mL ampules (NDC 00781-3040-95)

Estimated Resupply Dates

All presentations are currently available.

Implications for Patient Care

Pyridostigmine is an acetylcholinesterase inhibitor labeled to reverse the effects of nondepolarizing neuromuscular blocking agents after surgery.²

Safety

• The acetylcholinesterase inhibitors differ in potency, onset of action, and duration of action. Use caution when switching between agents to prevent dosing errors.
• Pyridostigmine injection (Regonol) contains benzyl alcohol.²
  

Alternative Agents & Management

• Acetylcholinesterase inhibitors including edrophonium, neostigmine, and pyridostigmine are used to reverse non-depolarizing neuromuscular blocking agents. Depolarizing neuromuscular blocking agents (ie, succinylcholine) are not reversed by these agents and their toxicity may be worsened by concomitant administration.^3-6 
• Acetylcholinesterase inhibitors are usually given in combination with anticholinergic agents like atropine or glycopyrrolate in order to minimize adverse effects such as bradycardia from the acetylcholinesterase inhibitors. Edrophonium is available as a single agent (Enlon) and in combination with atropine (Enlon Plus). ^3-6
• The table below compares the available acetylcholinesterase inhibitors when used to reverse non-depolarizing neuromuscular blocking agents.