10.2.1 Drugs that enhance neuromuscular transmission

Anticholinesterases are used for myasthenia gravis Their muscarinic side effects, including bradycardia and an increase in sweating, salivary and gastric secretion and gastrointestinal and uterine motility, are all antagonised by atropine.

Neostigmine
  • Tablets 15mg (£99.60 = 140 tablets)
  • Injection

Indications

  • Myasthenia gravis

Dose

  • Oral 15–30mg at suitable intervals throughout day, total daily dose 75–300mg
Pyridostigmine
  • Tablets 60mg (£45.57 = 200 tablets)

Indications

  • Myasthenia gravis

Dose

  • 30–120mg at suitable intervals throughout day, total daily dose 0.3–1.2g
Ataluren
  • Granules for oral suspension 125mg, 250mg, 1000mg

Notes

  1. NICE HST3 Ataluren recommended for treating Duchenne muscular dystrophy with a nonsense mutation in the dystrophin gene (NHS England commissioned) (July 2016)
Nusinersen
  • Solution for injection vials 12mg in 5ml

Notes

  1. NICE TA588: Nusinersen (Spinraza) is recommended as an option for treating 5q spinal muscular atrophy (SMA), only when the criteria of the NICE TA are met (July 2019)
  2. MHRA Drug Safety Update (September 2018): Nusinersen (Spinraza): reports of communicating hydrocephalus; discuss symptoms with patients and carers and investigate urgently
Fampridine

Not routinely funded for multiple sclerosis. See NHS England Clinical Commissioning Policy Statement: Fampridine for Multiple Sclerosis

 

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