title: [Drugs that may trigger or exacerbate myasthenia gravis].
abstract: Myasthenia gravis (MG) is an autoimmune disease causing muscle weakness due to impaired transmission at the neuromuscular junction. MG or a MG-like condition may be triggered or exacerbated by several drugs used for treatment of other diseases. Drugs may interfere with the neuromuscular transmission through several mechanisms, either by affecting pre- or postsynaptic ion channels or by affecting acetylcholinesterase. Based on a literature search in PubMed and the authors' own clinical experiences, we provide an overview focusing on the most frequently used drugs that may exacerbate weakness in patients with MG. In our experience, symptomatic MG-patients who have a generalised disease are especially vulnerable to drug-induced exacerbations, while stable MG patients with few symptoms more seldom are. Nevertheless, patients with MG must receive treatment for co-existing conditions. It is important to be aware of a possible increase in muscle weakness when introducing a new drug. If the patient deteriorates, the new treatment must be withdrawn or the dose reduced.
authors: Nevrologisk avdeling, Oslo universitetssykehus, Rikshospitalet, Norway. ahmed.elsais@medisin.uio.no
authors: Ahmed
authors: A
authors: Elsais
authors: Trine Haug
authors: TH
authors: Popperud
authors: Øyvind
authors: Ø
authors: Melien
authors: Emilia
authors: E
authors: Kerty
mesh_terms: D000109:Acetylcholine / Q000378:metabolism; D000305:Adrenal Cortex Hormones / Q000009:adverse effects; D000319:Adrenergic beta-Antagonists / Q000009:adverse effects; D000617:Aminoglycosides / Q000009:adverse effects; D000700:Analgesics / Q000009:adverse effects; D000777:Anesthetics / Q000009:adverse effects; D000890:Anti-Infective Agents / Q000009:adverse effects; D000927:Anticonvulsants / Q000009:adverse effects; D001905:Botulinum Toxins / Q000009:adverse effects; D000075202:Contraindications; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000009:adverse effects; D008094:Lithium / Q000009:adverse effects; D018942:Macrolides / Q000009:adverse effects; D008278:Magnesium Sulfate / Q000009:adverse effects; D018908:Muscle Weakness / Q000139:chemically induced / Q000503:physiopathology; D009157:Myasthenia Gravis / Q000139:chemically induced* / Q000503:physiopathology; D009469:Neuromuscular Junction / Q000187:drug effects / Q000378:metabolism; D010396:Penicillamine / Q000009:adverse effects; D011950:Receptors, Cholinergic / Q000187:drug effects / Q000378:metabolism; D014612:Vaccines / Q000009:adverse effects
chemical_list: D000305:Adrenal Cortex Hormones; D000319:Adrenergic beta-Antagonists; D000617:Aminoglycosides; D000700:Analgesics; D000777:Anesthetics; D000890:Anti-Infective Agents; D000927:Anticonvulsants; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D018942:Macrolides; D011950:Receptors, Cholinergic; D014612:Vaccines; D008278:Magnesium Sulfate; D008094:Lithium; D001905:Botulinum Toxins; D010396:Penicillamine; D000109:Acetylcholine