A German study clarifies the risk and contraindications of cardiovascular drugs in Myasthenia gravis

Myasthenia gravis is caused by the deleterious action of antibodies produced by the individual and directed against one or more components of the neuromuscular junction. Characterized by a varianility of the resulting muscle impairment and by the presence of a synaptic block on the electromyogram, this non-hereditary neuromuscular disease can get significantly worse with certain drugs, some of which are widely prescribed in cardiological practice (including beta-blockers, anti-calciums, anti-arrhythmics). 

In an article published in June 2021, a team of German clinicians tried, using pharmacovigilance data made available by the World Health Organization (WHO), to specify the frequency of the side effects declared in the development of a myasthenia gravis and their attribution to this or that drug. Overall, accidents related to these cardiovascular drugs are rarer than those related to antibiotics or neuroleptics. The authors identified tizanidine, alpha-blockers, beta-blockers and anti-calciums as dangerous while the risk incurred is lower with salbutamol, angiotensin receptor inhibitors, oral anticoagulants and heparins. This article illustrates, once again, the interest of big data analysis, and allows to establish more precise drug contraindications for myasthenic patients. 


The risk of worsening of myasthenia by cardiovascular medication as reflected by reporting frequency. Peter Trillenberg , Alexander Katalinic , Julia Thern , Tobias Graf. Eur J Neurol. 2021 Sep;28(9):2965-2970