From the Guidelines
Illegal drug use can potentially worsen myasthenia gravis symptoms and should be avoided by patients with this condition. Many illicit substances, particularly cocaine, methamphetamine, and certain hallucinogens, can interfere with neuromuscular transmission and exacerbate muscle weakness, which is the hallmark symptom of myasthenia gravis. Marijuana may also worsen symptoms in some patients. These drugs can interact negatively with medications commonly prescribed for myasthenia gravis, such as pyridostigmine (Mestinon), prednisone, azathioprine, and mycophenolate mofetil. The mechanism behind this worsening involves disruption of acetylcholine transmission at the neuromuscular junction, which is already compromised in myasthenia gravis patients. Additionally, the stress and physiological changes associated with drug use and withdrawal can trigger myasthenic crises, potentially leading to respiratory failure requiring emergency intervention, as seen in patients with severe symptoms, such as those requiring ICU-level monitoring 1. Patients with myasthenia gravis should discuss all substances they use with their neurologist to ensure proper management of their condition and avoid potentially dangerous complications.
Some key considerations for managing myasthenia gravis include:
- Grading management based on symptom severity, with grade 2 symptoms (some symptoms interfering with ADL) requiring hold of immune checkpoint inhibitors and potential resumption if symptoms resolve 1
- Administering corticosteroids, such as prednisone, for grade 2 symptoms and weaning based on symptom improvement 1
- Permanently discontinuing immune checkpoint inhibitors for grade 3-4 symptoms, which include limiting self-care, weakness limiting walking, and respiratory muscle weakness 1
- Initiating IVIG or plasmapheresis for severe symptoms, along with frequent pulmonary function assessment and daily neurologic review 1.
It is essential to prioritize the patient's safety and well-being, and avoiding illegal drug use is crucial in managing myasthenia gravis, as it can help prevent worsening symptoms and reduce the risk of complications, such as myasthenic crises. While the provided evidence does not directly address the impact of illegal drug use on myasthenia gravis, the potential risks and interactions with medications are well-established, and patients should be advised to avoid such substances to ensure optimal management of their condition.
From the Research
Illegal Drug Use and Myasthenia Gravis
- There is no direct evidence in the provided studies that specifically addresses the impact of illegal drug use on myasthenia gravis.
- However, it is known that certain drugs can trigger or exacerbate myasthenia gravis by interfering with the neuromuscular transmission 2.
- The studies primarily focus on the treatment of myasthenia gravis using immunosuppressive therapies 3, 4, 5 and the potential of certain medications to cause exacerbations of the disease 2, 6.
- Some medications that can cause new onset or acute worsening of myasthenia gravis include those that activate the immune system or have actions on the neuromuscular junction 6.
- It can be inferred that any substance, including illegal drugs, that affects the neuromuscular junction or the immune system could potentially worsen myasthenia gravis, but more research is needed to confirm this.
Medications and Myasthenia Gravis
- Certain medications, such as macrolides, fluoroquinolones, β-blockers, and magnesium, should be used with caution in patients with myasthenia gravis as they can cause acute worsening of the disease 6.
- Immunosuppressant medications and acetylcholinesterase inhibitors are the mainstays of treatment for myasthenia gravis, although the evidence for their efficacy is limited 6.
- The treatment of myasthenia gravis tends to be patient-specific, and the risk of complications from immunosuppressive treatment depends on drug dosage, treatment duration, and patient characteristics 4.