Several common drugs can worsen myasthenia gravis. Fluoroquinolones and macrolides are the usual culprits in infection, and intravenous magnesium, some beta-blockers and aminoglycosides can also precipitate weakness.
When a patient with myasthenia presents with new weakness, ask what was started in the past few days, and choose an alternative antibiotic where possible.
- Ask about antibiotics started recently, especially fluoroquinolones and macrolides.
- Avoid intravenous magnesium and aminoglycosides unless essential.
- Review beta-blockers started recently.
- Watch breathing and swallowing in any flare, and have a low threshold to admit.
- Flag the diagnosis on prescriptions and in the emergency department record.
Why it matters
A drug trigger is often reversible and easy to miss during an infection.
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