Myasthenia gravis treatment steroids

Acetylcholinesterase inhibitors can provide symptomatic benefit and may not fully remove a person's weakness from MG. [45] While they might not fully remove all symptoms of MG, they still may allow a person the ability to perform normal daily activities. [45] Usually, acetylcholinesterase inhibitors are started at a low dose and increased until the desired result is achieved. If taken 30 minutes before a meal, symptoms will be mild during eating, which is helpful for those who have difficulty swallowing due to their illness. Another medication used for MG, atropine , can reduce the muscarinic side effects of acetylcholinesterase inhibitors. [46] Pyridostigmine is a relatively long-acting drug (when compared to other cholinergic agonists), with a half-life around four hours with relatively few side effects. [47] Generally, it is discontinued in those who are being mechanically ventilated as it is known to increase the amount of salivary secretions. [47] A few high-quality studies have directly compared cholinesterase inhibitors with other treatments (or placebo); their practical benefit may be such that it would be difficult to conduct studies in which they would be withheld from some people. [48] The steroid prednisone might also be used to achieve a better result, but it can lead to the worsening of symptoms for 14 days and takes 6–8 weeks to achieve its maximal effectiveness. [47] Due to the myriad symptoms that steroid treatments can cause, it is not the preferred method of treatment. [47] Other immune suppressing medications may also be used including rituximab . [49]

Caution should be used when high-dose prednisone is given to patients as up to 50% of patients may develop a transient deterioration with possible precipitation of MG crisis. The transient worsening usually occurs 5 to 10 days after dose initiation and lasts for about a week. For this reason, high-dose prednisone should be started in hospitalized patients receiving concurrent rapid induction immunotherapy. Alternatively, a slow dose escalation regimen should be used to reach a target dose of 1mg/kg (usually 50-80 mg/day) over 3 to 4 weeks. In patients with mild to moderate MG symptoms, a lower dose of 20 to 40 mg per day is sufficient.

Myasthenia gravis treatment steroids

myasthenia gravis treatment steroids

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