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What Is The Drug Of Choice For Myasthenia Gravis?

Myasthenia gravis is a chronic disease of the muscles that leads to weakness and tiring in them. It develops in skeletal muscles of the body that are important for locomotor activities. It starts with the affections of eye muscles that result in double vision, drooping of eyelids and blurred vision. It develops more commonly in women than in men. Its exact cause is not clear. Autoimmune reactions in the body may trigger this disorder. It cannot be cured. But its symptoms can be managed and the progress of the disease can be prevented.

What Is The Drug Of Choice For Myasthenia Gravis?

What Is The Drug Of Choice For Myasthenia Gravis?

The treatment of myasthenia gravis focuses to improve the flow of information between the nerves and muscles. Neostigmine is the drug of choice for myasthenia gravis. Its main function is to slow down the breaking of acetylcholine. This increases the availability of this chemical. More acetylcholine is released in the nerve endings and they are easily received by acetylcholine receptors and the strength of the muscles is improved.

Neostigmine can be consumed as tablets or is given intravenously. Doctors recommend them to be taken as tablets twice a day when you are most active for example; it is given in the morning or before meals. The doses are decided according to the age of the patient.

Neostigmine is not suitable in some cases such as pregnancy, breastfeeding, asthma, epilepsy, hyperthyroidism, etc. It is contradicted in people who have hypersensitivity to bromides or have peritonitis or urinary tract obstructions.

Neostigmine also causes some side effects on the body such as nausea, vomiting, abdominal cramps, dizziness, loss of consciousness, breathing problems, rashes, urticaria, etc. to avoid such side effects. Other medicines such as immunosuppressants or corticosteroids are prescribed that reduce muscle symptoms. (2)

Myasthenia gravis is a chronic autoimmune disorder characterized by weakness and tiring of the muscles that play an important role in locomotion. This happens due to a fault in the peripheral nervous system. It leads to a fault in the flow of information or impulses from nerves to the muscles. It can affect anybody in the age of 20-50 years of age. It affects women more than men. It affects skeletal muscles and eye muscles. Skeletal muscles help in the movement of the body. The eye muscles help in focusing the eye to various objects by rotating the eyeball. Their functions are impaired in this disorder.

It appears suddenly and often not recognizable. Initially, it causes the weakness of the eye muscles. It results in drooping of one or both eyelids and blurred vision due to the prolonged weakness of muscles that control eye movements. This disorder affects facial muscles that are involved in facial expression and swallowing. It leads to changes in facial expression, difficulties in swallowing and impaired speech. It may involve muscles of the chest that causes difficulties in breathing. When it affects skeletal muscles, it impairs one’s ability to perform physical abilities that lead to disability.

Myasthenia gravis is caused by autoimmunity which over activates the immune system. It attacks its own healthy tissues. In this disorder, the overactive immune system attacks and damages the acetylcholine receptors in the muscles. These receptors receive acetylcholine for the contraction of the muscles. Acetylcholine is the chemical released by the nerve endings that convey messages from nerves to muscles. In most of the patients of myasthenia gravis, acetylcholine does not reach muscles and muscles are not able to contract to get tightened. (1)


Myasthenia gravis is an autoimmune neuromuscular disease marked by impairment of the information between nerves and muscles. Neostigmine is the drug of choice for this disorder. It encourages the availability of acetylcholine to its receptors in the muscles. However, it too has some adverse effects on the body such as vomiting, diarrhea, rashes, etc.


  1. https://patient.info/medicine/neostigmine-for-myasthenia-gravis
  2. https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Myasthenia-Gravis-Fact-Sheet

Also Read:

Pramod Kerkar, M.D., FFARCSI, DA
Pramod Kerkar, M.D., FFARCSI, DA
Written, Edited or Reviewed By: Pramod Kerkar, M.D., FFARCSI, DA Pain Assist Inc. This article does not provide medical advice. See disclaimer
Last Modified On:June 22, 2021

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