ADVERSE EFFECTS OF CHOLINESTERASE INHIBITORS IN THE ELDERLY PATIENT WITH MYASTHENIA GRAVIS. CASE REPORTS
Myasthenia gravis (MG) is an autoimmune neuromuscular disease caused by the blockade of acetylcholine receptors at the post-synaptic neuromuscular junction. The clinical signs of MG are obvious in the young patient, but they may be misinterpreted in an elderly person with comorbidities either as manifestations of sarcopenia, as the onset of a minor stroke or “equivalents” of acute coronary syndrome or heart failure. Anticholinesterases (Pyridostigmine, Neostigmine) increase acetylcholine concentration at the neuromuscular junction and are the standard agents for symptomatic treatment; in elderly patients, their side-effects can easily be attributed to other age-related problems, such as bradycardia, arrhythmia or epigastric pain and nausea. We present two cases that illustrate the particularities of diagnosing and treating elderly patients with comorbidities and MG. We conclude that it is necessary to periodically monitor the elderly patient with MG for the early identification of adverse effects. It is also useful to remember that in the elderly patient with comorbidities and MG the risk of cholinesterase inhibitor overdose is increased, partly due to numerous concomitant drugs and partly due to low therapy adherence. Both statins and associated metabolic diseases are possible causes of disease progression, therefore caution is required in prescribing medication to the patient with myasthenia gravis.
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