Neostigmine Methylsulfate Injection shortage
Neostigmine Methylsulfate Injection is currently listed in shortage by the FDA. The FDA lists 1 affected product. This page was last refreshed from FDA data on Sep 22, 2026.
Fresenius Kabi is permanently stopping its neostigmine methylsulfate injection. Other manufacturers have not reported a shortage and still list this medicine as available.
Don’t stop or change your therapy on your own — talk with your prescriber about the plan that fits you, and ask your pharmacist what’s actually available (see options).
Do you take this drug? See the ‘What to do’ recommendation from Dr. Brian Staiger, PharmD →What’s in shortage — at a glance
These figures count only the manufacturers that reported this shortage to the FDA — not every company that makes Neostigmine Methylsulfate Injection. Other makers that haven’t reported a problem are shown in the green card below.
Shortage timeline
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Jan 12, 2026Currently in shortage1 of 1 product affected.
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Jan 12, 2026First reported to the FDA1 product first listed.
Built from FDA posting and update dates. The end date FDA publishes is the posting/update date, not a true resolution date, so durations are approximate.
What exactly is on backorder — by manufacturer
Manufacturer: Fresenius Kabi USA, LLC 📞 888-386-1300 1 NDC click to expand
| Status | NDC / product | Strength | Availability | Related information | Reason |
|---|---|---|---|---|---|
| To Be Discontinued | Neostigmine Methylsulfate, Injection, .5 mg/1 mL (NDC 63323-413-10) | — | — | Discontinuation of the manufacture of the drug | — |
These rows are manufacturer reports to the FDA for Neostigmine Methylsulfate Injection — they do not necessarily cover every manufacturer that makes this drug. A company appears here only if it told the FDA it has a supply problem, so other makers may still have stock. That’s the basis for the Where else can I get Neostigmine Methylsulfate Injection? options further down this page.
Why is Neostigmine Methylsulfate Injection in shortage?
Fresenius Kabi USA, LLC has reported to the FDA that they are permanently stopping the production of their specific version of Neostigmine Methylsulfate Injection — the 0.5 mg/1 mL strength (the 10-pack vial presentation). This isn't a temporary hold-up at the factory or a supply hiccup; it's a permanent decision to stop making that particular product.
As for why they made that business decision, Fresenius Kabi did not share a specific public reason with the FDA. No additional details — such as a timeline or which other strengths or package sizes might continue — were included in this report.
Based on the manufacturer-reported reason(s) and notes on file with the FDA for Neostigmine Methylsulfate Injection, summarized in plain English by HelloPharmacist. A drug can be short for more than one reason, and the FDA updates these as manufacturers report changes.
What should I do if I take Neostigmine Methylsulfate Injection?
Neostigmine Methylsulfate Injection is currently on the FDA shortage list, and I want to walk you through what this means for you.
The one strength on this record, 0.5 mg/1 mL, has no available source from the manufacturer that filed this report (Fresenius Kabi). Their reason is straightforward: they are discontinuing the manufacture of this product. Because this is a planned discontinuation rather than a temporary delay, this particular supply problem may be permanent for that maker. It's important to know this report reflects only Fresenius Kabi — other companies make this same medicine and may still be supplying it.
Here is what I suggest, in order:
- Do not stop, skip, or change how this medicine is used on your own. Because this is an injection typically given by a clinician, your care team manages dosing and supply.
- Ask your pharmacy or care team to check wholesalers and other manufacturers — several companies (such as Amphastar, Hikma, Sagent, Par Health, and others) are listed as making the same medicine, though it may not be in local stock right now.
- If your exact product cannot be found, ask your prescriber or pharmacist about an equivalent option from another maker.
The manufacturer's contact number is listed on this page for reference; pharmacies usually handle those calls.
- Don’t stop or change the medication on your own — talk to your prescriber first.
- If this is part of an ongoing or essential regimen (for example HIV treatment or prevention, seizure, heart, transplant, diabetes or mental-health medicines), do not skip or ration doses — contact your pharmacist or prescriber right away to arrange continued supply before you run out.
- Ask your pharmacy to check other manufacturers, strengths, package sizes, and nearby stores.
- Ask your prescriber whether a different strength, formulation, or the brand/generic version is appropriate.
Uses, dosing, side effects, prices, and the complete FDA label — written in plain English and pharmacist-reviewed.
Where else can I get Neostigmine Methylsulfate Injection?
FDA shortages are manufacturer-reported — a company only shows up on the shortage list if it told the FDA it has a supply problem, so not every maker of Neostigmine Methylsulfate Injection is necessarily short. Below we pull together the other still-marketed options that are not reported in shortage: the same medicine from manufacturers that haven’t reported a problem, and alternative dosage forms. These may still be out of stock at your pharmacy, and only your prescriber or pharmacist can decide what’s right for you.
Same medicine, other manufacturers (not reported short)
Same active ingredient, dosage form & route as the shortage (matched on the FDB HICL ingredient code), from makers that have not filed a shortage with the FDA:
| Product | Strength | Form / route | Manufacturer | NDC |
|---|---|---|---|---|
| Neostigmine Methylsulfate | NEOSTIGMINE METHYLSULFATE .5 mg/mL | Injection · Intravenous | Amphastar Pharmaceuticals, Inc. | 00548-9601-00 |
| Neostigmine Methylsulfate | NEOSTIGMINE METHYLSULFATE 1 mg/mL | Injection · Intravenous | Amphastar Pharmaceuticals, Inc. | 00548-9602-00 |
| Neostigmine Methylsulfate | NEOSTIGMINE METHYLSULFATE 1 mg/mL | Injection · Intravenous | Hikma Pharmaceuticals USA Inc. | 00641-6149-10 |
| Neostigmine Methylsulfate | NEOSTIGMINE METHYLSULFATE .5 mg/mL | Injection · Intravenous | Hikma Pharmaceuticals USA Inc. | 00641-6150-10 |
| Neostigmine Methylsulfate | NEOSTIGMINE METHYLSULFATE .5 mg/mL | Injection · Intravenous | Heritage Pharmaceuticals Inc. d/b/a Avet Pharmaceuticals Inc. | 23155-0517-41 |
| Neostigmine Methylsulfate | NEOSTIGMINE METHYLSULFATE 1 mg/mL | Injection · Intravenous | Heritage Pharmaceuticals Inc. d/b/a Avet Pharmaceuticals Inc. | 23155-0518-41 |
| Neostigmine Methylsulfate | NEOSTIGMINE METHYLSULFATE .5 mg/mL | Injection, Solution · Intravenous | Sagent Pharmaceuticals | 25021-0610-10 |
| Neostigmine Methylsulfate | NEOSTIGMINE METHYLSULFATE 1 mg/mL | Injection, Solution · Intravenous | Sagent Pharmaceuticals | 25021-0611-10 |
| Neostigmine Methylsulfate | NEOSTIGMINE METHYLSULFATE 1 mg/mL | Injection · Intravenous | Camber Pharmaceuticals Inc. | 31722-0995-31 |
| Neostigmine Methylsulfate | NEOSTIGMINE METHYLSULFATE .5 mg/mL | Injection · Intravenous | Par Health USA, LLC | 42023-0188-10 |
| Neostigmine Methylsulfate | NEOSTIGMINE METHYLSULFATE 1 mg/mL | Injection · Intravenous | Par Health USA, LLC | 42023-0189-10 |
| Neostigmine | NEOSTIGMINE METHYLSULFATE .5 mg/mL | Injection · Intravenous | Dr.Reddy's Laboratories Inc | 43598-0528-11 |
Alternative dosage forms of Neostigmine Methylsulfate
A different form of the same drug (for example a solution when capsules are short). A form change is a clinical decision — ask your prescriber:
Therapeutic equivalents & pricing 19 productsclick to expand
Orange Book–rated equivalents of the affected strengths, with the latest NADAC price (a federal retail-acquisition benchmark, not your copay) and an evidence-based availability label. Cheapest first.
| Product | Manufacturer | Package | NADAC $/unit | AB rating | Availability |
|---|---|---|---|---|---|
| Neostigmine Methylsulfate .5 mg/mL | Amphastar | 1 vial | — | AP | FDA listed |
| Neostigmine Methylsulfate .5 mg/mL | Hikma | 10 vials | — | AP | FDA listed |
| Neostigmine Methylsulfate .5 mg/mL | Hikma | 10 vials | — | AP | FDA listed |
| Neostigmine Methylsulfate .5 mg/mL | Indoco | 1 vial | — | AP | FDA listed |
| Neostigmine Methylsulfate .5 mg/mL | Heritage | 10 vials | — | AP | FDA listed |
| Neostigmine Methylsulfate .5 mg/mL | Sagent | 10 vials | — | AP | FDA listed |
| Neostigmine Methylsulfate .5 mg/mL | Par | 10 vials | — | AP | FDA listed |
| Neostigmine .5 mg/mL | Dr.Reddy's | 1 vial | — | AP | FDA listed |
| Neostigmine Methylsulfate .5 mg/mL | Eugia | 10 vials | — | — | FDA listed |
| Neostigmine Methylsulfate .5 mg/mL | Fresenius | 10 vials | — | AP | FDA listed |
| Neostigmine Methylsulfate .5 mg/mL | Caplin | 10 vials | — | AP | FDA listed |
| Neostigmine methylsulfate .5 mg/mL | Gland | 1 vial | — | AP | FDA listed |
| Neostigmine Methylsulfate .5 mg/mL | Somerset | 10 vials | — | AP | FDA listed |
| Neostigmine methylsulfate .5 mg/mL | Amneal | 10 vials | — | AP | FDA listed |
| Neostigmine Methylsulfate .5 mg/mL | Xellia | 10 vials | — | AP | FDA listed |
| Neostigmine methylsulfate .5 mg/mL | Xiromed | 1 vial | — | AP | FDA listed |
| neostigmine methylsulfate .51 mg/mL | Meitheal | 10 vials | — | AP | FDA listed |
| Neostigmine methylsulfate .5 mg/mL | BE | 10 vials | — | AP | FDA listed |
| neostigmine methylsulfate .5 mg/mL | Camber | 10 vials | — | AP | FDA listed |
Equivalents share the same ingredient, strength, dosage form and route; an AB rating means the FDA considers them substitutable. NADAC is a national retail-pharmacy acquisition benchmark from CMS — not what you pay. Availability is inferred from recent pricing, not a stock check.
Other drugs in the same treatment class
These are different medicines — not other versions of Neostigmine Methylsulfate Injection — that fall in the same broad treatment class (cholinesterase inhibitors) . They are not automatic substitutes: they can differ in how they work, dosing, effectiveness, side effects and what they’re approved to treat. Do not switch on your own. This list is for information only — ask your prescriber or pharmacist whether any of them is appropriate for you.
Identity & classification
Where does this data come from?
Other analgesia/addiction shortages
Neostigmine Methylsulfate Injection shortage FAQs
Is Neostigmine Methylsulfate Injection in shortage?
Which products are affected?
When will Neostigmine Methylsulfate Injection be available again?
Can I still get Neostigmine Methylsulfate somewhere?
What should I do if I take Neostigmine Methylsulfate Injection?
Still have a question about the Neostigmine Methylsulfate Injection shortage?
Ask a pharmacist about this shortage →View Neostigmine Methylsulfate Injection on the FDA drug-shortage database →
Where does this data come from?
/drug/shortages) — drug, manufacturer & contact, NDC/product, status, availability, reason, therapeutic category and posting/update dates. Current / To Be Discontinued = active; Resolved is kept for history. The Supply-Risk rating is assessed per active ingredient and adds the FDA NDC Directory (still-marketed manufacturers by ingredient & form); same-medicine and equivalent products use First Databank classification + CMS NADAC pricing; Medicaid use + most-affected states come from CMS Medicaid State Drug Utilization Data. Reference only — confirm current status with the manufacturer or FDA before acting on it.