Myasthenia Gravis - The Resource

 

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MEDICATIONS

There are several medications used in the treatment of this disorder:

Anticholinesterase medications such as neostigmine (Prostigmin®) and pyridostigmine (Mestinon®) are usually prescribed. These drugs prevent ACh destruction and increase the accumulation of ACh at neuromuscular junctions, improving the ability of the muscles to contract. Side effects include excessive salivation, involuntary muscle twitching (fasciculation), abdominal pain, nausea, and diarrhea. A drug called kaolin may be used with anticholinesterase medications to reduce gastrointestinal side effects.

  1. Prostigmin - side effects
  2. Prostigmin - drug interactions and precautions
  3. Mestinon - side effects
  4. More Mestinon information
  5. Official Mestinon site
  6. Mestinon information from the FDA (.pdf file)

Corticosteroids (e.g., prednisone) suppress the antibodies that block AChR at the neuromuscular junction and may be used in conjunction with anticholinesterase. Corticosteroids improve symptoms within a few weeks and once improvement stabilizes, the dose is slowly decreased. A low dosage may be used indefinitely to treat MG; however, side effects such as gastric ulcers, osteoporosis (bone thinning), weight gain, high blood sugar (hyperglycemia), and increased risk for infection may develop over the long term.

  1. Prednisone side effects
  2. More on Prednisone
  3. Prednisone information from WebMD
  4. General steroid information

Immunosuppressants such as azathioprine (Imuran®), cyclophosphamide (Cytoxan®) and mycophenolate mofetil (CellCept®) are used to treat generalized MG when other medications fail to reduce symptoms. Side effects may be severe and include low white blood cell count (leukopenia), liver dysfunction, nausea, vomiting, and hair loss.

  1. Imuran - side effects
  2. More on Imuran
  3. Cytoxan - side effects
  4. More on Cytoxan
  5. Cytoxan information from FDA
  6. Official CellCept manufacturer site
  7. CellCept information
  8. MGFA brochure about CellCept (.pdf file)
  9. CellCept information from FDA (.pdf file)

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An Article describing drugs that could aggravate MG from the MGFA in UK.

Medications Contraindicated for Patients with Myasthenia Gravis (from the Detroit MGFA)

Aminoglycosides: Tobramycin,
Gentamicin,
Streptomycin,
Kanamycin,
Neomycin,
Amikacin,
Paromomycin Amitriptyline*, Bactracin**
Barbiturates*
Beta-Blockers: Propranolol,
Oxprenolol,
Pindolol,
Practolol,
Sotalol,
Timolol (ophthalmic)** Chloroquine* Chlorpromazine**
CNS Depressants* Colchicine
Colistin 		Colistimethate** Corticosteroids** Decamethonium Diphenhydramine* Duiretics*
Droperidol* Echotheophate
Emetine* Erythromycine** Ethosuximide*
Gallamine
Haloperidol*
Impiramine*
Lidocaine
Lincomycin
Lithium**
Magnerium Sulfate Muscle Relaxants* Narcotics: Morphine,
Codine,
Meperidine,		 Hydromorophone,
Opium (Pantopan (R))
Pancuconium Paraldehyde* Penicillamine
Phentyoin Procainamide**
Procaine
Quinine**
Respiratory:
Depressants* Sulfonamides** Sedatives*
Sodium Lactate** Succinylcholine Tetacycline**
Thyroid:
Replacements Tranquilizers* Trihexphenidyl Tubocurarine
* theoretically may worsen MG - no clinical reports ** worsens MG or causes MG-like syndrome Henry Ford Hospital 1993

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