Myasthenia gravis is characterized by fatigable muscle weakness. May worsen or precipitate MG. Use with caution. If you have myasthenia gravis, it’s not unusual to be taking multiple medications. Page History Some children are born with a rare, hereditary form of myasthenia, called congenital myasthenic syndrome. Nonetheless, medications that have been implicated in myasthenia gravis are reported in the Table, and these agents should be used cautiously in this population.
In 2011 the US Food and Drug Administration Adverse Event Reporting System was queried for reports of myasthenia gravis exacerbations occurring in patients taking fluoroquinolones.Macrolides have a possible association with myasthenia gravis that follows a similar timecourse to the fluoroquinolones.Numerous antipsychotics have been associated with myasthenia gravis exacerbation.A recent retrospective study evaluated the association of myasthenia gravis with low-osmolality contrast agents.Glucocorticoids, although a mainstay in the management of moderate to severe myasthenia gravis, can also cause muscle weakness.A number of reports are available associating immune checkpoint inhibitors such as avelumab, ipilimumab, pembrolizumab, tremelimumab, nivolumab, sintilimab, and atezolizumab with myasthenia gravis. CMS When a medication is suspected, it is often withdrawn – at least temporarily.In summary, many drugs have been implicated as a cause of myasthenia gravis or disease exacerbation. Any muscle group can be involved, but the initial presentation typically involves the ocular muscles, with diplopia and ptosis. 3. Some children are born with a rare, hereditary form of myasthenia, called congenital myasthenic syndrome. To date, development or exacerbation of MG has been reported for pembrolizumab, although it has also been seen with nivolumab, ipilimumab and other ICIs. Below is a short, incomplete list of medications that can worsen symptoms in patients suffering from myasthenia gravis (MG). Certain medications and over the counter preparations may cause worsening of MG symptoms.
Posted January 6, 2017. 1800 802 568 Although the literature is limited, caution and close monitoring when prescribing these agents is recommended, especially during an acute exacerbation.833 S. Wood St., Suite B12, College of Pharmacy, (MC 886), Chicago, IL 60612 View Visio File We recommend using the latest version of IE11, Edge, Chrome, Firefox or Safari.Myasthenia gravis is a rare autoimmune disease with a prevalence of approximately 14 to 20 cases per 100,000 people.Normally, muscle contraction depends on the binding of acetylcholine released from motor nerve terminals to postsynaptic receptors on the muscle end-plate region.Muscle fatigue and weakness are the key presenting symptoms of myasthenia gravis.Many medications are implicated in either inducing or worsening myasthenia gravis or affecting neuromuscular transmission.Because evidence of exacerbations or first presentations of myasthenia gravis have mainly been published in case reports, it is difficult to determine a true incidence with each agent. That way you can share consistent and complete information with all of your health care providers. Export to PDF People who did not have MG before beginning immunotherapy have a higher likelihood of developing the disease , although worsening of myasthenic weakness has been reported in people with existing, previously-diagnosed MG. - Drugs that may unmask or worsen myasthenia gravis; RELATED TOPICS. Drugs implicated as potentially harmful in myasthenia gravis patients based on either anecdotal case reports or in-vitro microelectrode studies. The pathophysiology remains unknown, but generally signs and symptoms begin within 2 to 6 weeks of treatment with these agents.Approximately 1% of patients treated with penicillamine develop autoimmune myasthenia gravis.Although statins are known to cause myotoxicities, myasthenia gravis exacerbations have not been well-reported in the literature.It is possible for a number of medications to contribute to myasthenia gravis.
New research finds biomarkers for myasthenia gravis, an autoimmune condition, that may help diagnose it and create individualized treatments in the future. Below is a list of drugs that can make myasthenia worse; while reading it, try to remember these very important general guidelines:-When the myasthenia is well controlled, the safety factor of nerve→muscle transmission has been largely restored, which is why the patient is stronger. Likewise, doctors evaluating new-onset weakness in cancer patients on immunotherapy should consider MG. Additionally, MG with ICIs can be accompanied by inflammation of skeletal and/or heart muscle. 2. © Copyright 2020 Myasthenia Gravis Foundation of America, Inc. Risk may increase with administration of combinations of ICIs. **Approved by the MGFA Medical/Scientific Advisory BoardCheckpoint inhibitors: Immunotherapy for cancer is an exciting treatment advance for many types of cancers.