Drugs with Interactions in Myasthenia Gravis (MG)
| Drugs That May Exacerbate MG |
| Antibiotics |
| Aminoglycosides: e.g., streptomycin, tobramycin, kanamycin |
| Quinolones: e.g., ciprofloxacin, levofloxacin, ofloxacin, gatifloxacin |
| Macrolides: e.g., erythromycin, azithromycin |
| Nondepolarizing muscle relaxants for surgery |
| D-Tubocurarine (curare), pancuronium, vecuronium, atracurium |
| Beta-blocking agents |
| Propranolol, atenolol, metoprolol |
| Local anesthetics and related agents |
| Procaine, Xylocaine in large amounts |
| Procainamide (for arrhythmias) |
| Botulinum toxin |
| Botox exacerbates weakness |
| Quinine derivatives |
| Quinine, quinidine, chloroquine, mefloquine (Lariam) |
| Magnesium |
| Decreases acetylcholine release |
| Penicillamine |
| May cause MG |
| Drugs with Important Interactions in MG |
| Cyclosporine |
| Broad range of drug interactions, which may raise or lower cyclosporine levels. |
| Azathioprine |
| Avoid allopurinol—combination may result in myelosuppression. |