What Milestone Pharmaceuticals does

Milestone Pharmaceuticals is a commercial-stage biopharmaceutical company founded in 2005 and headquartered in Montreal, Canada, with a U.S. operating subsidiary in Charlotte, North Carolina. The company is publicly traded on NASDAQ under the ticker MIST and employs between 11 and 50 people. Milestone develops small molecule therapeutics for episodic cardiovascular conditions, with its core asset being etripamil — a novel calcium channel blocker (new chemical entity) delivered as a nasal spray via Aptar's Bidose Liquid Nasal Spray System. The product, branded CARDAMYST, received FDA approval on December 12, 2025 as the first and only self-administered nasal spray treatment for acute symptomatic episodes of paroxysmal supraventricular tachycardia (PSVT) in adults, representing the first new PSVT therapeutic option in over 30 years. Beyond the approved PSVT indication, the pipeline includes etripamil in Phase 3 for atrial fibrillation with rapid ventricular rate (AFib-RVR) and Phase 1/2 for pediatric PSVT.

The company transitioned to commercial operations in early 2026, with CARDAMYST available across U.S. retail pharmacies by late January 2026 and a national sales force deployed in mid-February 2026 targeting cardiologists and electrophysiologists. Revenue is generated primarily from CARDAMYST product sales, supplemented by licensing and milestone payments from regional partners — notably the $30 million upfront from Everest Medicines for Greater China rights (March 2026) and the $125 million strategic financing from RTW Investments. Pricing follows a specialty-pharma patient assistance model with a projected $25 copay cap for commercially insured patients, and formulary access has been secured across 85 million lives via Express Scripts (55 million) and UnitedHealth (30 million from July 1, 2026). Through April 2026, approximately 600 prescriptions had been filled for 560 patients by 400 unique prescribers, generating $240,000 in Q1 2026 product revenue and $1.5 million in Q4 2025.

The company's underlying technology combines a novel short-acting calcium channel blocker engineered for sub-10-minute nasal absorption and minimal duration of systemic effect with a proprietary dual-dose delivery device (Aptar Bidose). Milestone holds FDA approval, an EMA decision pending in Q1 2027 (branded Tachymist in Europe), and a China NMPA decision expected in Q3 2026 via its partner Everest Medicines. The product profile — 64% conversion to sinus rhythm within 30 minutes versus 31% on placebo in the RAPID trial, median conversion time of 18.5 minutes, and only 0.4% hypotension / 0.2% syncope across 1,610 self-treated patients — underpins a positioning aimed at displacing emergency-department visits for acute PSVT episodes. The dual-headquartered, low-headcount structure is characteristic of a recently-launched specialty pharma: heavy on commercial execution and clinical development, light on enterprise overhead, with a market capitalization of approximately $240 million as of April 2026.

Name

Milestone Pharmaceuticals

Legal name

Milestone Pharmaceuticals Inc.

Website

https://milestonepharma.com

Company type

Public

Founded year

2005

Operating status

Operating

Headcount range

11–50 employees

Short description

Milestone Pharmaceuticals is a commercial-stage biopharmaceutical company developing novel small-molecule cardiovascular therapeutics, with CARDAMYST (etripamil) — the first FDA-approved self-administered nasal spray for acute PSVT in adults — serving cardiologists, electrophysiologists, and the ~2 million U.S. PSVT patients.

Ownership category

akta.pro rank

Product category

Cardiovascular Pharmaceuticals

NAICS

Pharmaceutical and Medicine Manufacturing (3254)

akta.pro primary industry

Cardiometabolic Pharmaceuticals (Cardiovascular/Diabetes/Obesity) (HLAIAAAE)

akta.pro secondary industry

Cardiology & Vascular Specialty Pharmaceuticals (HLAIACAG)

Keywords

• Cardiovascular therapeutics
• Acute PSVT treatment
• Nasal spray medication
• Calcium channel blocker
• Self-administered drugs

Headquarters

HQ city

Montréal

HQ country

Canada

HQ region

North America

Offices2 records

Markets served

GTM type

B2B

Offering type

Hardware or Manufacturing

Cost components

Personnel, Technology or R&D, Marketing or Sales, Operations, Supply Chain

Revenue model

1. CARDAMYST Product Sales: Commercial-stage biopharmaceutical company generating revenue from sales of FDA-approved CARDAMYST (etripamil) nasal spray following its mid-February 2026 launch. The product is available through U.S. retail pharmacies.
2. Licensing and Milestone Payments: Received $30 million upfront payment from Everest Medicines for Greater China rights to CARDAMYST, with potential milestone payments of up to $20 million.
3. Royalty Financing: $125 million strategic financing agreement with RTW Investments including royalty funding commitment supporting FDA approval and launch of Etripamil.

Pricing tiers

Go-to-market motion1 record

Distribution channels3 records

Marketing channels5 records

Core offering

Milestone Pharmaceuticals develops, manufactures, and commercializes small molecule therapeutics for cardiovascular diseases. Its primary commercial product is CARDAMYST (etripamil) nasal spray, a novel calcium channel blocker self-administered by adult patients for the acute treatment of symptomatic episodes of paroxysmal supraventricular tachycardia (PSVT), delivered via Aptar's Bidose nasal spray system.

Product overview

Milestone Pharmaceuticals is a commercial-stage biopharmaceutical company focused on cardiovascular medicines. The company's primary product is CARDAMYST (etripamil) nasal spray, an FDA-approved, self-administered nasal spray for treating acute symptomatic episodes of paroxysmal supraventricular tachycardia (PSVT) in adults—the first such treatment approved in over 30 years. The active ingredient is etripamil, a novel calcium channel blocker. Beyond the approved PSVT indication, the company is advancing etripamil through Phase 3 development for atrial fibrillation with rapid ventricular rate (AFib-RVR) and Phase 1/2 for pediatric PSVT, representing pipeline expansion opportunities. CARDAMYST is delivered via an Aptar Bidose Nasal System and was launched commercially in the U.S. in early 2026 following December 2025 FDA approval.

Differentiator

Problem solved

Functional benefit

Brands

• CARDAMYST: FDA-approved nasal spray (etripamil) for treatment of paroxysmal supraventricular tachycardia (PSVT) in adults
• Tachymist

Products and services

• CARDAMYST (etripamil) nasal spray FDA-approved, self-administered nasal spray for the conversion of acute symptomatic episodes of paroxysmal supraventricular tachycardia (PSVT) to sinus rhythm in adults. It is the first and only FDA-approved self-administered treatment for PSVT, delivered via an Aptar Bidose Nasal System.

Quantifiable outcome

• 64% of etripamil users converted to normal heart rhythm within 30 minutes versus 31% on placebo (Phase 3 RAPID trial)
• +2 more outcomes

Named customers1 record

Segments3 records

Ideal customer profiles3 records

Technology focussed Yes

API detail

Has API

No

API docs

API detail

Core technology

AI maturity

App detail

Feature3 records

Partnerships

Four partnerships are on record, tiered minor, core and major.

• Duke Clinical Research InstituteminorStrategic or Co-development Partner · 10 April 2026Leading the RESET-PSVT registry, a Phase 4 observational study to gather real-world evidence on CARDAMYST use for PSVT in adults. Enrollment beginning late 2026 across approximately 20 U.S. sites.
• Everest MedicinescoreOEM/ Whitelabel/ Licensing Partner · 23 March 2026Asset Purchase Agreement for Greater China rights to CARDAMYST (etripamil) nasal spray. $30 million upfront payment plus potential milestone payments of up to $20 million. Everest acquired development and commercialization rights from Corxel Pharmaceuticals. China's NMPA accepted NDA in January 2025 with expected approval in Q3 2026.
• Corxel PharmaceuticalsmajorStrategic or Co-development Partner · 23 March 2026Original licensing partner for Greater China region. Everest Medicines entered into Asset Purchase Agreement with Corxel to acquire CARDAMYST rights for Greater China.
• Aptar GroupcoreTechnology or Integration · 18 December 2025Aptar's Bidose Liquid Nasal Spray System delivers CARDAMYST (etripamil) nasal spray. First use of Aptar's dual Bidose delivery system in a combination product for cardiovascular treatment.

Scale indicators14 records

Recent moves6 records

Expansion highlights8 records

Direct peers

• Cardiome Pharma: Previously public specialty CV company that developed and commercialized Brinavess (IV vernakalant) for AFib; acquired by ADVANZ PHARMA. Comparable as a small-cap arrhythmia-focused commercial-stage biopharma.
• Acasti Pharma: Cardiovascular specialty pharma (NASDAQ: ACST) focused on hypertriglyceridemia. Comparable as a small-cap public cardiovascular company with limited commercial revenue and reliance on capital markets to fund operations.
• Impel Pharmaceuticals: Specialty pharma focused on intranasal drug delivery (POD technology) for CNS indications. Comparable through its emphasis on nasal delivery as a differentiated administration route for acute outpatient treatment.
• InCarda Therapeutics: Private clinical-stage company developing InRhythm, an inhaled formulation of flecainide for self-administration in PSVT and AFib. Most directly comparable to Milestone's CARDAMYST in terms of indication, delivery modality, and patient target.
• Correvio Pharma: Formerly independent specialty cardiovascular company that commercialized Brinavess (vernakalant) for AFib; now part of AOP Health. Closest historical precedent for a small-cap arrhythmia specialty pharma commercializing a single acute-care cardiovascular asset.
• Esperion Therapeutics: Small-cap U.S. specialty cardiovascular pharma (NASDAQ: ESPR) commercializing lipid-lowering therapies (Nexletol, Nexlizet). Comparable in cardiovascular specialty focus, public small-cap status, and reliance on a single commercial asset during ramp.
• Cytokinetics: Cardiac specialty biopharma (NASDAQ: CYTK) developing cardiac myosin modulators for HCM and heart failure. Comparable as a U.S. small-cap cardiology-focused innovator with novel mechanism, late-stage pipeline, and specialty commercial ambitions.
• Lexicon Pharmaceuticals: Specialty biopharma (NASDAQ: LXRX) with focus on cardiovascular and metabolic disease. Similar in scale, public small-cap status, and dependence on a small commercial portfolio plus pipeline inflection events.
• Madrigal Pharmaceuticals: U.S. small-cap specialty biopharma (NASDAQ: MDGL) with a recently launched single commercial product (Rezdiffra). Comparable trajectory to Milestone: small market cap, single commercial asset, concentrated launch execution, and high investor sensitivity to ramp.

Emerging players

• Tenaya Therapeutics: Cardiac-focused clinical-stage biotech (NASDAQ: TNYA) developing gene therapies for genetic cardiomyopathies. Comparable as a small-cap public cardiac innovator with similar headcount scale and pipeline-stage risk profile, though addressing a different modality.

Market position

Strengths4 records

Weaknesses4 records

Competitive moat5 records

Key risks6 records

Key highlights7 records

Customer concentration

• LinkedInlinkedin.com/company/milestone-pharmaceuticals
• Xx.com/milestonepharma

Revenue estimate

Valuation estimate

Number of profiles

Profiles13 records

Funding overview

Funding rounds10 records

Investors20 records

Funding detail is available on the Subscription and Enterprise plan.Contact sales →

M&A

Investments

M&A and investment is available on the Subscription and Enterprise plan.Contact sales →

Frequently asked questions about Milestone Pharmaceuticals