Corticosteroids anticholinesterases

Treatment with guanidine may produce clinical improvement within 3 to 4 days. Side effects include paresthesia, gastrointestinal distress, renal tubular necrosis, and hyperirritability. The most serious effect is bone marrow depression, which is dose-related and potentially fatal. Aminopyridines have been used in clinical studies with some positive results. Corticosteroids and plasmapheresis may also be of some benefit, whereas anticholinesterase agents are only marginally effective. 

Qll The number of normal acetylcholine receptors decreases as the disease progresses. This reduces the effectiveness of anticholinesterases. In such cases, immunosuppressant therapy, using a corticosteroid, can be used. This will help to reduce the formation of antibodies to acetylcholine receptors. In... 

Most patients show improvement with corticosteroids. Steroids may be of optimum benefit when added to another therapeutic regimen such as anticholinesterase therapy or immunosuppressants such as azathioprine. Moderate-dose daily prednisone for 4 to 6 weeks, followed by low-dose alternate-day therapy as needed, has been foimd to improve ocular motility and decrease the development of generalized myasthenia. Steroid therapy must be used cautiously in these patients because of the worrisome character and incidence of unwanted effects of these drugs. It is possible for patients to develop immunosuppression such that tapering of... 

Drug therapy has to be tailored to individual patients and includes anticholinesterase drugs, anti-inflammatory corticosteroids and immunosuppressant drugs. 

Anti-inflammatory corticosteroids, for example prednisolone, can be used to suppress the antibody formation in myasthenia gravis. They should be used together with anticholinesterase drugs and once an improvement is seen the dose should be decreased. 

Corticosteroids Anticholinesterases Anticholinesterase effeds may be antagonized in myasthenia gravis. 

Engel WK. (1976) Myasthenia gravis, corticosteroids, anticholinesterases. Ann NY Acad Sci 274, 623-630. 

The miotic effect of anticholinesterase eye-drops may be potentiated by dexpanthe-nols such as pantothenic acid, a member of the B-vitamin group which forms a part of co-enzyme A, and by clofibrate (Atromid-S). Their effects may be antagonized by longterm corticosteroid therapy, anticholinergics, antihistamines, meperidine, sympatho-mimetics and tricyclic antidepressants. 

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