Select one or more newsletters to continue. Key: 1 - Contraindicated. In addition, these patients may be refractory to the usual doses of epinephrine used to treat acute hypersensitivity reactions and may require a beta-agonist such as isoproterenol.Major Potential Hazard, High plausibility. Data from one meta-analysis study suggest a greater reduction of mortality risk for nonselective beta-blockers than for beta-1 selective agents.Major Potential Hazard, High plausibility. Applies to: Heart Block, Sinus Node DysfunctionThe use of beta-adrenergic receptor blocking agents (aka beta-blockers) is contraindicated in patients with sinus bradyarrhythmia or heart block greater than the first degree (unless a functioning pacemaker is present). Cardioselectivity is not absolute and can be lost with larger doses.Major Potential Hazard, High plausibility. Management of myasthenia gravis In this article, Susan Allen describes the symptoms of myasthenia gravis and what support pharmacists can give M yasthenia gravis (MG) is an auto-immune disorder causing impaired neuromuscular transmission in skeletal muscle.

Patients should be advised not to discontinue treatment without first consulting with the physician.

Drugs and the risk of worsening the weakness in patients with Myasthenia Gravis Updated March 2014 Many medications have been reported to worsen weakness in patients with MG. To minimize this risk, cessation of beta-blocker therapy, when necessary, should occur gradually with incrementally reduced dosages over a period of 1 to 2 weeks. 1 Symptoms include drooping eyelids, blurred or double vision, weakness in the arms and legs, and difficulty chewing, swallowing, and breathing.

Therefore, patients with glaucoma or intraocular hypertension may require adjustments in their ophthalmic regimen following a dosing change or discontinuation of beta-blocker therapy.Moderate Potential Hazard, Low plausibility. Therapy with beta-blockers should be administered cautiously in patients with diabetes or predisposed to spontaneous hypoglycemia.Major Potential Hazard, High plausibility. Heart rate and ECG, particularly the QTc interval, must be closely monitored.Major Potential Hazard, High plausibility. Patients with renal impairment may be at greater risk for adverse effects from sotalol, including torsade de pointes and worsened ventricular tachycardia, due to decreased drug clearance. Therapy with sotalol should be administered cautiously in patients with renal impairment. Drugs that may aggravate Myasthenia Gravis Antimicrobials Many antibiotics have been shown to cause problems in myasthenics.

those that are likely to cause problems and should be avoided if possible, and Applies to: PsoriasisThe use of beta-blockers in psoriatic patients should be carefully weighed since the use of these agents may cause an aggravation in psoriasis.Moderate Potential Hazard, Moderate plausibility. Applies to: TachyarrhythmiaBeta-adrenergic blockade in patients with Wolff-Parkinson-White syndrome and tachycardia has been associated with severe bradycardia requiring treatment with a pacemaker. Ann Intern Med 83 (1975): 834-5 Berstein LP, Henkind P …

Proof that the drug was responsible for an exacerbation in MG is often very weak. They can have serious side effects.

Increases in serum VLDL and LDL cholesterol and triglycerides, as well as decreases in HDL cholesterol, have been reported with some beta-blockers. Applies to: Renal DysfunctionSotalol is primarily eliminated by the kidney. Applies to: Diabetes MellitusBeta-adrenergic receptor blocking agents (aka beta-blockers) may mask symptoms of hypoglycemia such as tremors, tachycardia and blood pressure changes. Applies to: hemodialysisTherapy with sotalol should be administered cautiously in patients with renal failure undergoing hemodialysis. the use of non-selective beta blockers is not recommended in these patients. In patients with pheochromocytoma, an alpha-blocking agent should be initiated prior to the use of any beta-blocking agent. Since cardioselectivity is not absolute, larger doses of beta-1 selective agents may demonstrate these effects as well. Use cautiously in patients with myasthenia gravis.Moderate Potential Hazard, Moderate plausibility. In many instances, reports of worsening MG are very rare. Several beta-blockers have been associated rarely with aggravation of muscle weakness in patients with preexisting myasthenia gravis or myasthenic symptoms. If signs or symptoms suggesting reduced cerebral blood flow are observed, consideration should be given to discontinuing these agents.Moderate Potential Hazard, Moderate plausibility. Caution should be taken in the administration of these agents to patients suspected of having pheochromocytoma.Moderate Potential Hazard, Moderate plausibility. Applies to: Myoneural DisorderBeta-adrenergic receptor blocking agents (aka beta-blockers) may potentiate muscle weakness consistent with certain myasthenic symptoms such as diplopia, ptosis, and generalized weakness. Major Potential Hazard, High plausibility. Key Words: Myasthenia gravis, anesthesia, thymectomy. Applies to: Peripheral Arterial DiseaseDue to their negative inotropic and chronotropic effects on the heart, beta-adrenergic receptor blocking agents (aka beta-blockers) reduce cardiac output and may precipitate or aggravate symptoms of arterial insufficiency in patients with peripheral vascular disease. Patients should be advised not to discontinue treatment without first consulting with the physician.

Drugs that may aggravate Myasthenia Gravis A brief guide for patients, doctors and dentists. Due to their negative inotropic and chronotropic effects on the heart, the use of beta-blockers is likely to exacerbate these conditions.Major Potential Hazard, High plausibility.