Prevention of myasthenia gravis is not possible.
Existing myasthenia gravis may be worsened by the following factors:
- Inflammation
- Fever
- Heat
- Hormonal fluctuations – during menstruation.
- Infections
- Physical stresses
- Medications (A claim to completeness does not exist!)
- Analgesics
- Flupirtine
- Morphine preparations
- Antiarrhythmic drugs – quinidine, ajmaline, mexitil, procainamide.
- Antibiotics
- Aminoglycosides – v. a. Streptomycin, Neomycin, less Tobramycin.
- Macrolides – e.g., erythromycin
- Ketolides – telithromycin/Ketek
- Lincomycins
- Polymyxins
- Gyrase inhibitors – levofloxacin, ciprofloxacin, prulifloxacin.
- Sulfonamides
- Tetracyclines
- Penicillins – only in particularly high dosage.
- Antidepressants – amitriptyline-type substances.
- Anticonvulsants – benzodiazepines, carbamazepine, diphenylhydantoin, ethosuximide, gabapentin.
- Antimalarials – quinine, chloroquine and analogs.
- Antirheumatic drugs – chloroquine, etanercept
- Beta-blockers – oxprenolol, pindolol, practolol, propranolol, timolol – also used topically as eye drops.
- Botulinum toxin
- Calcium antagonists – verapamil, diltiazem, nifedipine and relatives.
- Diuretics – acetazolamide, benzothiadiazines, loop diuretics.
- Glucocorticoids (clinically relevant worsening is rare at intermediate doses or insipid dosing)
- Interferons – interferon-alpha (isolated cases).
- Lithium
- Local anesthetics – procaine (ester type), the amide type substances used today are not problematic.
- Magnesium – high doses as laxatives (laxatives).
- Muscle relaxants
- Curare derivatives – due to increased sensitivity, initially (starting) choose 10-50% of normal dosage
- Succhinylcholine – Should generally not be used because it cannot be antagonized with pyridostigmine!
- Narcotics
- Psychotropic drugs – chlorpromazine, promazine and relatives, all benzodiazepines and structural relatives such as zolpidem, zopiclone
- Statins – several reports of findings on various cholesterol-lowering drugs.
- Analgesics
- Thyroid disease
- Mental stress
- Vibrations