ASK THE PHARMACIST
High-Risk Medications in Myasthenia Gravis: Practical Guidance for Emergency Care By Lisa Hayes, PharmD and Judah Brown, PharmD on behalf of the SAEM Academy of Emergency Medicine Pharmacists
SAEM PULSE | JULY-AUGUST 2026
At a Glance
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• Why this matters now: Patients with myasthenia gravis frequently present to the emergency department with conditions requiring medications that can inadvertently worsen neuromuscular weakness or precipitate disease exacerbations. • What you’ll learn: Which commonly used medications pose the greatest risk in myasthenia gravis, the mechanisms behind those risks, and practical treatment alternatives and prescribing considerations for emergency clinicians. • Who this is for: Emergency physicians, residents, pharmacists, and advanced practice providers who prescribe, administer, or manage medications in patients with myasthenia gravis.
Background
Myasthenia gravis (MG) is an autoimmune neuromuscular disease known to cause fatigue and weakness of the face, extremities, and respiratory muscles. MG is characterized by the development of antibodies to the nicotinic acetylcholine receptor (AChR) in the postsynaptic membrane of the neuromuscular junction. It is reported that approximately 37 per 100,000 people in the United States have MG. In the emergency setting, patients with MG may present