Important Guidance

When the myasthenia is well controlled, the safety factor of nerve→muscle transmission has been
largely restored, which is why the patient is stronger. If so, the listed drugs are unlikely to cause
a major problem. Mild worsening may be noticed and one must keep on the lookout.

Obviously, therefore, patients with poorly controlled myasthenia are most at risk from such drugs.
Infections (e.g. pneumonia) can make myasthenia worse (myasthenic crisis). If it is a serious
infection, then one of the powerful antibiotics on the list may have to be used, with the risk of
making the myasthenia worse still. The hospital specialists need to be fully aware of all of the
potential problems and must be ready to deal with them

Any reaction to any drug can be very specific to the individual patient – including worsening of
myasthenia. Some drug reactions are rare and most people with myasthenia would never get
them.

Some drugs have been proved to affect nerve → muscle transmission. Many others are suspects
but have never actually been tested. Indeed our only evidence against them may be that one MG
patient became weaker after taking it. Myasthenia weakness can vary a lot from day to day without
any obvious cause, so some drugs have probably been blamed unfairly for a dip that was purely
coincidental.

The take-home message is very simply to check the list of suspect drugs when starting any new
one. If it is there, both the MG patient and the prescribing doctor should be aware that it might
worsen the patient’s myasthenia. They should also remember that, with any drug, they might be
the first to notice a problem, especially if that drug is an unusual one, or a newcomer. Its absence
from the list is not a cast-iron guarantee of an easy ride.

The tables give warnings, not a list of banned drugs. While doctors will always try and use safe
alternatives, some of those on the list may be life-saving (e.g. for a resistant germ). If they really
are needed, it may still be possible to control any effects on the myasthenia.

All drugs have what is known as a proper, or generic, name. These are sometimes rather long
and complicated and drug manufacturers use shorter names, not least so that they can patent
them. A single drug may be known by literally dozens of brand names. Also, drugs are sometimes
combined and prescribed under a name that doesn’t clearly indicate the individual components.
It is now recommended that doctors only use the proper (generic) names of drugs – the only ones
used here. If popular trade names were used, there would be a danger of omissions; also, such
names may come and go.

Every drug, whether prescribed by the doctor or bought over the counter, has to be labelled with the
proper name – so check that!
 Antibiotics & Beta - Other Heart Drugs Used In Neurology &
Antimalarials Blockers Drugs Psychiatry
Acrosoxacin Acebutolol Procainamide Chlorpromazine
Amikacin Atenolol Quinidine Clozapine
Azithromycin Betaxolol Flupenthixol
Cinoxacin Bisoprolol Isocarboxacid
Ciprofloxacin Carvedilol Lithium
Chloroquine Celiprolol Loxapine
Doxycycline Esmolol Methotrimeprazine
Erythromycin Labetolol Oxypertine
Gentamicin Metoprolol Pericyazine
Hydroxychloroquine Nadolol Perphenazine
Kanamicin Oxprenolol Phenelzine
Levofloxacin Pindolol Pimozine
Lymecycline Propranolol Prochlorperazine
Minocycline Sotalol Promzine
Naladixic Acid Timolol Phenytoin
Netilmicin Risperidone
Norfloxacin Sulpiride
Ofloxacin Thioridazine
Oxytetracycline Tranylcypromide
Streptomycin Trifluoroperzaine
Telithromycin Zuclopenthixol
Tetracycline
Tobramycin

Antibiotics and Anti-Malarials

These are used to treat infections and are amongst the commonest drugs prescribed by GPs. Remember that
the infection rather than the drug might be worsening in the myasthenia and it may be hard to know which
to blame. The antibiotics most likely to worsen myasthenia are usually given in hospital, by injection, for
very serious infections.

The one exceptional drug that must be avoided in myasthenias is the ketolide antibiotic, Telithromycin
(Ketek) which has caused deaths.

Drugs for malaria are also sometimes used to treat rtheumatic problems.

Drugs for the Heart

Beta blockers are widely used to treat high blood pressure and angina and occasionally also for anxiety.
A fairly common side-effect is a feeling of tiredness but in rare cases they can specifically worsen
myasthenia. New ones are being introduced all of the time so this list may not be complete.
Most of their names end in -olol