From the Guidelines
Alcohol consumption should be limited to 1-2 alcoholic beverages per day for patients with myasthenia gravis, as excessive alcohol intake can worsen symptoms and interact with medications. Alcohol acts as a central nervous system depressant and can intensify muscle weakness, which is already a primary symptom of myasthenia gravis. The neuromuscular junction, where nerve signals trigger muscle contractions, is already compromised in myasthenia gravis due to antibodies blocking acetylcholine receptors. Alcohol further interferes with neuromuscular transmission, potentially exacerbating weakness, fatigue, slurred speech, double vision, and difficulty swallowing or breathing. Some key points to consider include:
- Limiting alcohol intake is conditionally recommended for patients receiving glucocorticoid treatment, as stated in the 2017 American College of Rheumatology guideline 1
- Avoiding medications that can worsen myasthenia gravis, such as β-blockers, IV magnesium, fluoroquinolones, aminoglycosides, and macrolides, is also crucial, as mentioned in the American Society of Clinical Oncology clinical practice guideline 1
- Patients with myasthenia gravis should monitor their symptoms carefully and discuss alcohol consumption with their neurologist to understand their individual risk factors.
- Additionally, alcohol can interact negatively with medications commonly prescribed for myasthenia gravis, such as pyridostigmine (Mestinon), prednisone, azathioprine (Imuran), and mycophenolate mofetil (CellCept), potentially reducing their effectiveness or increasing side effects.
From the Research
Myasthenia Gravis and Alcohol
- There is no direct evidence in the provided studies to suggest that alcohol makes myasthenia gravis worse 2, 3, 4, 5, 6.
- The studies focus on the treatment of myasthenia gravis, including the use of pyridostigmine, corticosteroids, and immunosuppressive therapies, but do not mention the effects of alcohol on the disease.
- It is essential to note that myasthenia gravis is a complex and heterogeneous disorder, and treatment strategies may vary depending on the individual patient's needs and circumstances.
Treatment of Myasthenia Gravis
- Pyridostigmine is a commonly used medication for the symptomatic treatment of myasthenia gravis, and its effectiveness and side effects have been studied 4.
- Corticosteroids and immunosuppressive therapies, such as azathioprine, are also used to induce remission or minimal manifestations in patients with more than mild myasthenia gravis 3, 5, 6.
- Thymectomy is a surgical option for patients with acetylcholine receptor antibody-positive generalized myasthenia gravis, and its benefits have been demonstrated in clinical trials 5.
Management of Myasthenia Gravis
- A practical approach to managing patients with myasthenia gravis involves prompt symptom control and the induction of remission or minimal manifestations 5.
- Treatment needs to be individualized, taking into account the patient's age, comorbidities, and specific disease characteristics.
- Novel therapies, including biological drugs and new targets of the immune pathway, are being developed and trialed to improve treatment options for myasthenia gravis 6.