Hey Annie,

I have a wallet card created by the Ontario MG chapter written by Dr. Nicolle. They bolded the most commonly reported problem drugs. I'm at work at the moment, but I'll send you the list that Dr. Nicolle put on this as well as his note to the doctors when I get a chance. It is 4 double-sided business card sized.

Brian.

That would be an excellent idea!! I would appreciate it greatly as I really don't know what to combine.

Here's what I have provided by the Ontario MG Chapter
It was written by Dr. M.W.Nicolle, MD, FRCPC, C.Phil and last updated in Nov 2010.

Many medications have been reported to worsen weakness in patients with MG. Proof that the drug was responsible for an exacerbation in MG is often weak. Typically, more MG patients can take these medications without ill effect than will become weak because of them. Caution is still advised.

TO THE DOCTOR:
The risk that a given medication will exacerbate MG must be balanced by the need for the drug, lack of a suitable substitute and the gravity of the situation requiring the use of the drug. None of the medications listed are absolutely contraindicated in patients with MG. Whenever possible, substitutes should be used.

If there are no acceptable substitutes, the patient should be monitored closely for signs of worsening MG. If respiratory or bulbar (swallowing) functions are already seriously compromised, consideration should be given to monitoring in an inpatient setting when the medication is started.

They then put in contact information space for your family doctor and neuro.

Drugs which are most consistently reported as potentially being a problem are in bold

Antibiotics
Aminoglycosides
Neomycin
Gentamicin
Streptomycin
Kanamycin
Tobramycin
Macrolides
Erythromycin
Clarithromycin
Azirthromycin etc.

Fluoroquinolones
Norfloxacin
Offaxocin
Cirporfloxacin etc
Others:
Amikacin
Polymixin B
Colistin
Tetracyclines
Oxytetracyclines
Lincomycin & Clindamycin
Ampicillin

Cardiovascular Drugs
Beta Blockers (including topical/ocular-probably safe)
Quindine
Procainamide
Calcium Channel Blockers
Verapamil, Nimodipine & perhaps other calcium channel blocers - also probably safe
Clonidine
Bretylium (high doses)
ACE inhibitors May potentiate bone marrow suppression if on azathioprine

CNS Active
Diphenylhydantoin/Phenytoin
Trimethadione
Lithium
Chlorpromazine, Promazine
Trihexyphenidyl
Morphine and other narcotics
benzodiazapines & barbiturates - probably safe unless significant bulbar or respiratorty compromise is present
Amantadine

Anti-Rheumatic
Chloroquine
D-Penicillamine - can cause MG in some individuals, usually reversable
Prednisone - high doses can temporarily worsen MG within the first 1-2 weeks. There is NO reaction between Mestinon & Prednisone

Anaesthetic Agents
non-depolerizing agents
Pancuronium, Vecuronium and Atacurium - increased sensitivity in MG
Succinylcholine - Decreased effect in MG, increased if on pyridostigmine

Other
Allopurinol - increases risk of azathioprine toxicity
Procaine & Lidocaine (iv)
no risk for local anaesthetics

Magnesium - if given at doses to raise serum MG level

Bretylium
Topical Ophalmic drugs - Timolol, Beaxol, Echothiophate are probably safe.
Quinine - probably safe in beverages
Lactate
Iodinated contrast agents
Citrate Anti-Coagulant
Diphenhydramine
Emetine

Hope that gives you a good starting point to work from there Annie.

Brian.

Wow, Brian, thank you very much! I guess I'll have to do a regular list and a "mini" list for printing for the wallet. Good ideas.

I'm not doing so great, guys, so be patient about the results. Once I put a draft together, then you guys can have at it. Thanks again for all of the help.

Annie

Let me know if you want this for a sticky.... I think it should have its own...and not be buried with others.

Thanks, Mrs. D. I did read that somewhere but momentarily forgot! That would be a great idea.