Drugs commonly used during anesthesia that should be used with caution or avoided in patients with myasthenia gravis

Neuromuscular blocking agents^*

Local anesthetics, systemic^¶

Antibiotics

Aminoglycosides (eg, gentamicin, amikacin, tobramycin)
Fluoroquinolones (eg, ciprofloxacin, levofloxacin, moxifloxacin)
Macrolides (eg, azithromycin, erythromycin)

Cardiovascular drugs

Beta blockers
Procainamide
Quinidine

Glucocorticoids (eg, dexamethasone, hydrocortisone, methylprednisolone)

This is not a complete list of drugs that may affect neuromuscular transmission and worsen myasthenia gravis. If such drugs are used they should be administered cautiously with appropriate monitoring. For further information refer to UpToDate content.

MG: myasthenia gravis.

* Response to neuromuscular blocking agents is unpredictable in patients with myasthenia gravis. Use only when necessary, guided by neuromuscular monitoring.

¶ High doses or infusion of intravenous lidocaine should be avoided or used cautiously in patients with MG. Experimental and anecdotal evidence suggests that local anesthetics can affect neuromuscular transmission and could exacerbate MG.

Patients with MG are likely not at increased risk of complications if local anesthetics are used for regional anesthesia.

The duration of action of ester local anesthetics (eg, chloroprocaine) may be prolonged in patients who take anticholinesterases for treatment of MG.

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Drugs commonly used during anesthesia that should be used with caution or avoided in patients with myasthenia gravis