Drugs Used in Neuromuscular Disorders

Prescribing Notes:

• Treatment for myasthenia gravis should only be initiated on specialist advice.
• Edrophonium is used in hospital as a diagnostic test for myasthenia gravis.
• PYRIDOSTIGMINE BROMIDE 60mg orally is approximately equivalent to neostigmine 15mg orally, or 1mg to 1.5mg by intramuscular or subcutaneous injection.
• PYRIDOSTIGMINE BROMIDE has a longer duration of action than NEOSTIGMINE and is first choice for oral use. NEOSTIGMINE is useful in patients requiring parenteral treatment.
• An antimuscarinic (e.g. PROPANTHELINE 15mg orally as required up to 3 times daily or adjusted to individual circumstances) may be required to treat side-effects such as sweating, colic, excessive salivation and diarrhoea.
• In more severe cases, prednisolone ± a corticosteroid-sparing agent (AZATHIOPRINE) may be prescribed under specialist supervision for myasthenia gravis. Prophylactic bone protection should be considered in patients anticipated to receive 7.5mg or above of prednisolone daily for longer than 3 months, depending on other risk factors such as dose, age and medical history.

Prescribing Notes:

• The CSM has advised that serious side-effects can occur following abrupt withdrawal of BACLOFEN; therapy should be discontinued by gradual dose reduction over at least 1 to 2 weeks (longer if symptoms occur). 

• Liver function tests should be performed before commencing DANTROLENE, and at intervals during therapy. 

Acute Exacerbations of Multiple Sclerosis

Prescribing Notes: 

Acute Exacerbations of Multiple Sclerosis

• Urine screening should be performed for infection and glycosuria prior to commencing steroid therapy.
• Steroids reduce the duration of symptoms but do not influence the level of eventual disability.
• Usually no more than 2 courses of steroids are recommended annually.
• Multiple sclerosis patients may require therapy for bladder instability or spasticity.
• The decision to treat with steroids depends on the severity of the symptoms. Specialist advice should be sought from the patient’s neurologist or via the Multiple Sclerosis Nurse Specialist. 

Disease Modifying Agents for Multiple Sclerosis

• INTERFERON BETA and GLATIRAMER ACETATE are recommended for the treatment of patients with multiple sclerosis who meet criteria laid down by the Association of British Neurologists. A specialist clinic has been established at the Queen Elizabeth University Hospital (QEUH) to assess patients for suitability for treatment. If agreed, prescribing will be initiated by the QEUH with funding for the drug provided by NHS Lanarkshire.
• INTERFERON BETA requires 3 monthly monitoring of full blood count, liver function tests and GGT. Development of thrombocytopenia, persistent elevation of liver enzymes, or depression may require discontinuation of therapy; contact specialist clinic at the QEUH.
• GLATIRAMER does not require blood monitoring. The specialist clinic at the QEUH should be contacted if there is concern that a patient may be developing side-effects with GLATIRAMER. 
• Other disease modifying agents e.g. AZATHIOPRINE, may be used under specialist supervision.