Items Which MAY Aggravate Myasthenia Gravis

Alcohol: more than 1 or 2/day of liquor, wine, beer

Anesthetics and Sedatives

                Neuromuscular blocking agents (Vecuronium, etc.)

                Methoxyflurane and other inhaled anesthetics, succinylcholine, ketamine, barbiturates, narcotics,                          (codeine, morphine, hydromorphone, etc.)

Antibiotics

                Aminoglycosides: ex. gentamicin, neomycin, streptomycin, tobramycin

                Fluoroquinolones: ciprofloxacin (Cipro), levofloxacin (Levoquin), moxifloxacin

                Azithromycin (Zithromax, Z-pak)

                Erythromycin, Ampicillin, Clindamycin, lincomycin

                Sulfonomides (Bactrim)

                Tetracycline, minocycline, doxycycline

                Malaria prevention: hydroxychloroquine/chloroquine,mefloquine, doxycycline

Anticonvulsants

                Phenobarbital, phenytoin, gabapentin >2400mg/d, carbamazepine, oxcarbazine

Anti-Inflammatories/Immunosupressants

                Cholchicine, D-penicillamine, hydroxychloroquine,chloroquine, alpha-interferon

Bladder spasm meds: tolterodine (Detrol), oxybutynin (Ditropan), hycosamine (levbid),

                fesoterodine (Toviaz), solifenacin (vesicare), darifenacin (enablex), trospium                 

                (sancuta), flavoxate (urispas).

                Tamsulosin (Flomax), Mirabegron (myrbetriq) and vibegron (gemtesa) are OK

Cardiovascular

                Beta blockers: atenolol, propanolol, metoprolol, timolol, nadolol, labetalol

Calcium channel blockers: verapamil, nifedipine, diltiazem, nicardipine, amlodipine

                Quinidine, procainamide, Rythmol (propafenone)

                Statins: atorvastatin, fluvastatin, simvastatin, pravachol, rosuvastatin, lovastatin

Corticosteroids (high doses)

Glaucoma eye drops: timolol (in Timoptic, Combigan, Cosopt)

Hypokalemia (usually caused by diuretics): furosemide, HCTZ, etc

Muscle Relaxants

                 Botox, methocarbamol, carisoprodol, metaxalone, cyclobenzaprine

Over-the-counter: diphenhydramine (Benadryl) for allergies, milk of magnesia for constipation, Lomotil                               (diphenoxylate/atropine) for diarrhea

Psychiatric Medication

                 diazepam, clonazepam, alprazolam, lorazepam ,

                 Chlorpromazine, phenylzine, haloperidol

                 Amitriptyline, nortriptyline, imipramine, Lithium

                 Amantadine

Hyperthyroidism medication: methimazole (rare)

Misc.    Magnesium by iv, D-L carnitine (supplement), tropicamide (pupil dilator), iodinated radiology contrast, ritonavir, desferroxamine, Immune checkpoint inhibitors (Keytruda, Tecentriq, podivo, jemperli, libtayo, infinzi, bavencio, etc)

 

Always discuss side effects of medication with your physician. Never discontinue a medication without notifying your physician first. Many Myasthenia gravis patients are able to use these medications without side effects.

 

Updated 01/24/2024