Drugs and Vaccines to Avoid in Myasthenia Gravis
If you have myasthenia gravis (MG), you are likely aware that there are a number of prescription and over-the-counter drugs that you should avoid. Some of these medications are known to worsen MG symptoms, however, it doesn’t necessarily mean that you will never be prescribed one of these therapies.
In some cases, your doctor may opt to prescribe these drugs if the potential benefits outweigh the risks. Nevertheless, tell your physicians, dentists, and pharmacists that you have MG so that these drugs can be avoided when possible.
Avoiding certain drugs
Some people newly diagnosed with MG may wonder why the list of drugs to avoid is so extensive compared to other conditions. This is because MG is a neuromuscular disorder, meaning it affects the nerves and muscles. Many drugs work on the neuromuscular level, for example, by blocking neuromuscular function. Therefore, using these drugs can worsen symptoms of MG.
Use with caution
Your healthcare team is the best source of advice on which drugs are not optimal, depending on the severity of your MG. The below list of drugs to avoid is not comprehensive; there are other drugs that should be used in caution:
Medications that affect respiration - such as benzodiazepines (e.g., Ativan), opioids (e.g., codeine), sedatives (e.g., Imovane)
Antibiotics - Fluroquinolone class of medications (e.g., levofloxacin, ciprofloxacin) can worsen muscle weakness in some people. In some cases, a different antibiotic can be used. For people who cannot use a different antibiotic, this class of antibiotics should be used with caution.1
Aminoglycosides - These should be avoided and used only if there are no other alternatives. This class of medications can aggravate symptoms (e.g., gentamicin, neomycin, and tobramycin) 2
Magnesium sulfate - Magnesium sulfate is usually contraindicated, meaning it should not be used at all.2 On the other hand, magnesium derived from diet is fine in moderate doses. A diet that is too high in magnesium and supplements may cause problems. Only use magnesium supplements when supervised by your doctor.
Anesthesia – In some cases, anesthesia is required for surgery. In people with MG, using anesthesia can delay recovery.3
Certain heart drugs - These drugs should be used with caution.
Beta blockers - These drugs are used to reduce blood pressure and/or heart rate. (e.g., propranolol, bisoprolol, and metoprolol.)
Statins - This class of medications help reduce cholesterol. Statins may exacerbate MG symptoms. However, they are not absolutely avoided in MG. In some people with MG, it is still okay to be on a statin, but you will be monitored more frequently to ensure that there are no side effects.4
Immunizations and vaccines
Stay on top of immunizations to minimize the risk of infectious disease. Infections can increase the chance of MG flares.5
While most vaccines are safe to use in people with MG, some live vaccines are not recommended, particularly if you are also on prednisone, mycophenolate, or azathioprine. An example of a live vaccine is the nasal flu vaccine.
The COVID vaccine is not a live vaccine and is recommended for most people with MG.
Have you experienced an MG flare due to a medication or immunization? Share your experiences below.
Have you ever experienced remission in your myasthenia gravis?