What the FDA labels say about taking them together
Atropine and pyridostigmine
Pyridostigmine's FDA label of December 2, 2020 names atropine in its contraindications section; the atropine labels PlainMeds reads (4) do not name pyridostigmine. The pyridostigmine label: “WARNINGS AND PRECAUTIONS At the first sign of soman poisoning, pyridostigmine must be stopped, and atropine and 2-PAM must be administered immediately. …”
Check it at the source: the atropine FDA label on DailyMed (effective May 18, 2026, Hospira, Inc.); the pyridostigmine FDA label on DailyMed (effective December 2, 2020, Bausch Health US, LLC).
What does the atropine label say about pyridostigmine?
Atropine's label (effective May 18, 2026) and its 3 other brand-application labels do not name pyridostigmine in these sections. A label lists what its studies and reports found; it is not a complete list.
Source: FDA drug label (Atropine Sulfate), Hospira, Inc., effective May 18, 2026 (SPL set ad8916e7-206e-409e-2582-30d072845dd4), via openFDA; the full label on DailyMed
What does the pyridostigmine label say about atropine?
Pyridostigmine label, contraindicationsCare should be observed in the use of atropine for counteracting side effects, as discussed below.
Pyridostigmine label, warningsThe immediate use of atropine in cholinergic crisis is also recommended.
Pyridostigmine Bromide label (Surgeon General-Department of the Army (TSG-DA), December 23, 2025), boxed warningRISKS WITH IMPROPER USE OF PYRIDOSTIGMINE BROMIDE After Exposure to Soman, Use Atropine and Pralidoxime Pyridostigmine bromide is for use as a pretreatment for exposure to soman nerve agent.
Pyridostigmine Bromide label (Surgeon General-Department of the Army (TSG-DA), December 23, 2025), drug interactionsAtropine antagonizes the muscarinic effects of pyridostigmine bromide, and this interaction is utilized to counteract the muscarinic symptoms of pyridostigmine bromide toxicity.
Pyridostigmine Bromide label (Surgeon General-Department of the Army (TSG-DA), December 23, 2025), warnings and precautionsWARNINGS AND PRECAUTIONS At the first sign of soman poisoning, pyridostigmine must be stopped, and atropine and 2-PAM must be administered immediately. ( 5.1 ) Use with caution in persons with increased risk of anticholinergic reactions, such as persons with bronchial asthma, chronic obstructive pulmonary disease, bradycardia, cardiac arrhythmias, beta blocker treatment (increased risk of anticholinergic reactions). ( 5.2 ) Use with caution in persons with bromide sensitivity. ( 5.3 ) In case of serious adverse reactions, advise personnel to temporarily discontinue pyridostigmine and seek immediate medical attention.
Source: FDA drug label (Pyridostigmine Bromide, NDA020414), Surgeon General-Department of the Army (TSG-DA), effective December 23, 2025 (SPL set 0b296555-c32f-42db-b5f3-ea981a3dd2f8), via openFDA
Source: FDA drug label (Mestinon), Bausch Health US, LLC, effective December 2, 2020 (SPL set a851795e-b7a8-40c3-9922-5e79d3eb4d92), via openFDA; the full label on DailyMed
These are the labels' own sentences. PlainMeds does not grade interactions; a pharmacist or prescriber can say what they mean for one person's medicines.
Both medicines on the record
| Atropine | Pyridostigmine | |
|---|---|---|
| Labeled for | n/a | n/a |
| Boxed warning | No | No |
| Pharmacy cost (NADAC) | $7.74 per mL 1% eye drops | $0.249 per tablet 60 mg tablet |
| Shortage now | In shortage | No current entry |
Source: FDA NDC Directory, CMS NADAC of October 7, 2026 and the FDA Drug Shortage Database (FDA files October 8, 2026)
What next?
- Check more medicines together
- up to five at once