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Pyridostigmine
- Oral Acetylcholinesterase Inhibitor
- It increases the amount of ACh in the synaptic cleft
- Side effects: Significant gastrointestinal symptoms
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Corticosteroid Therapy
- Corticosteroids suppress the immune system
- Indicated for myasthenia gravis patients with mild symptoms who don't respond to conventional treatments
- Prednisone: Increase dose slowly (to avoid myasthenic crisis) until symptoms are gone, always taper off a corticosteroid
- Side effects: Weight gain, cataracts, diabetes, insomnia, mood change, osteoporosis
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Immunosuppressive drugs
- Used in severe myasthenia gravis patients
- Results in a profound decrease in immune response
- Azathoprine, cyclosporine, cyclophosphamide
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Plasma Exchange (Plasmapheresis)
Removes circulating antibodies (temporary improvement)
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Intravenous Immunoglobulin Infusion
- Unknown mechansim
- Temporarily relieves condition
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Thymectomy
- Removal of the thymus gland (not a good idea in patients <20 years old)
- Option for moderate to severe seropositive myasthenia gravis patietns who aren't controlled by drug therapy
- Only for patients <45 years old (past that age removing the thymus has little effect)
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