In patients with mild myasthenia gravis, medicines called acetylcholinesterase inhibitors (e.g.
pyridostigmine) are usually prescribed to increase muscle strength. They work by increasing
the effect of the chemical messenger (acetylcholine) which transmits information from the
nerves to the muscles. If the symptoms cannot be controlled using these drugs the next
stage of treatment is some form of immunosuppressant to help increase muscle strength.
1
2
Steroids such as prednisolone are the immunosuppressant that is usually prescribed first.
Some patients have other conditions, such as diabetes, where steroids are best avoided. In
others, the myasthenic symptoms cannot be fully controlled with steroids without them
causing side effects. In these patients another immunosuppressant (usually azathioprine)
may be prescribed. Combining steroids with a second immunosuppressant often allows a
smaller dose of steroids to be used, minimising side effects, such as osteoporosis.