ASK A PHARMACIST |
ASK THE PHARMACIST
Welcome to MGFC newest link, ASK THE PHARMACIST. We invite all MG patients
with questions about medications, dosage and possible side effects to post questions on
this link. Simply email your questions to info@myasthenia-ca.org and put ASK THE
PHARMACIST in the subject line.
Our friendly pharmacist, Alan Huber, will answer your questions as quickly and
completely as possible.
Dr. Alan Huber
Dr. Alan Huber was educated as a clinical pharmacist with Bachelor's Degrees in
Pharmacy and Zoology from the University of Maryland and a Doctor of Pharmacy
Degree from Shenandoah University. He is currently an Adjunct Assistant Professor of
Pharmacy Practice for the University Of Southern California School Of Pharmacy.
After completing a 2 year Internship in IV therapy at the National Institutes of Health in
Bethesda, Maryland, he has worked in the home infusion field for the past 15 years,
serving in various positions throughout the industry including managing several
nationally accredited home infusion companies.
We hope you enjoy learning about pharmaceutical aspects of Myasthenia Gravis and
welcome your comments and suggestions.
Dear Doc,
I just attended a support group for MG and hear other patients talking about IVIG.
What is it? Is it superior to the Mestinon I’m taking now. What does it cost? Does
insurance pay? I live in Glendale.
Intravenous Immunoglobulin (IVIG) is a plasma protein replacement therapy which is
obtained from blood donors. The pooled plasma goes through a rigorous process of
fractionation (obtaining the IgG antibodies from the pooled plasma) and a viral
inactivation process for manufacturing IVIG free of any dangerous pathogens. Once
safely manufactured, it is administered to patients with immune deficiencies and various
autoimmune disorders including Myasthenia Gravis. Even though IVIG is considered an
off-label indication for MG and the cost can be very high, insurance companies are only
authorizing the use of IVIG for patients who develop a myasthenic exacerbation such as
acute respiratory failure, difficulty in swallowing or any major functional disability
responsible for the discontinuation of physical activity. Until more studies are conducted
to determine the effectiveness of IVIG in the long term treatment of MG, it will be very
important for patients to work closely with their physicians and stay compliant with their
current therapies to prevent any exacerbations of their condition.
Dear Doc,
I take Mestinon every four hours and it helps my MG but it destroys my stomach. Any
recommendations? I don’t want to take anything that will interfere with the Mestinon or
that will exacerbate my MG. Are over the counter drug a possibility?
Mestinon is a cholinesterase inhibitor that is used to prevent acetylcholine breakdown
which allows accumulation of acetylcholine for higher transmission of nerve impulses
across neuromuscular junctions. Typically patients tend to experience diarrhea, nausea
and abdominal cramps when they are initiated on Mestinon. Side effects will usually
resolve over time as long as you are very compliant with your dosing protocol. If you
tend to have gastrointestinal (GI) side effects that persist, many physicians will prescribe
propantheline (Pro-Banthine) along with Mestinon to counter the side effects.
Propantheline is an anticholinergic agent which works on the muscarinic receptors of the
GI tract that reduce GI spasms by relaxing the smooth muscle in your gut. Even though it
is an anticholinergic agent, do not be concerned because the low doses prescribed by your
physician do not affect the nicotinic receptors which are involved in muscle contraction.
As for over the counter drugs, (OTC) loperamide (Imodium) is considered a safe
medication for controlling diarrhea. Other OTC’s to consider would be an H-2 Blocker
such as ranitidine (Zantac) or famotidine (Pepcid) and the following Proton Pump
Inhibitor omeprazole (Prevacid OTC). Even though H-2 blockers and PPI’s are used
more traditionally for treatment of reflux, stomach ulcers and heartburn there may be
some beneficial effects for short term use.
Dear Doc,
Maybe it’s the prednisone, but I have a hard time falling asleep. I’m fine once I’m asleep
and rarely awaken in the night. Also, during the day I often feel jittery and nervous. I’m
losing weight even though everyone tells me you are supposed to gain on prednisone.
Please advise.
Some of the common side effects of long term corticosteroid therapy are insomnia, mood
swings, irritability and an increase in anxiety. The exact cause of these side effects are not
known but some researchers believe that prednisone breaks down muscle and releases
glucose in to your system and the higher than normal level of glucose in your system may
create some of those adverse effects. When I counsel patients who are about to start
taking prednisone, I warn them to be prepared for these side effects. Informing family
members would be very beneficial so they understand it is of no fault of yours or theirs. If
these side effects persist, contact your physician regarding possible dosing adjustments or
prescribing a medication to help with your insomnia or anxiety. For many patients taking
prednisone, weight loss may occur but it tends to vary from patient to patient. The
reasons for the weight loss may be due to a decrease in muscle mass and a decrease in
bone density. Prednisone can break down the proteins used to build muscle and that
tends to create a loss of muscle mass in patients. Exercise is an excellent way to maintain
your muscle tone along with a diet higher in protein because the extra protein can be used
to develop more muscle. Always consult with your physician or a nutritionist for the
proper amount of protein required in your daily diet. If you are taking prednisone on a
long term basis speak with your physician about having a bone density test performed as
a baseline because of the increased chance of developing osteoporosis. Talk to your
physician or nutritionist about taking calcium supplements or modifying your diet with
more calcium intake. Also include exercise with weight bearing routines to maintain your
bone strength.
Welcome to MGFC newest link, ASK THE PHARMACIST. We invite all MG patients
with questions about medications, dosage and possible side effects to post questions on
this link. Simply email your questions to info@myasthenia-ca.org and put ASK THE
PHARMACIST in the subject line.
Our friendly pharmacist, Alan Huber, will answer your questions as quickly and
completely as possible.
Dr. Alan Huber
Dr. Alan Huber was educated as a clinical pharmacist with Bachelor's Degrees in
Pharmacy and Zoology from the University of Maryland and a Doctor of Pharmacy
Degree from Shenandoah University. He is currently an Adjunct Assistant Professor of
Pharmacy Practice for the University Of Southern California School Of Pharmacy.
After completing a 2 year Internship in IV therapy at the National Institutes of Health in
Bethesda, Maryland, he has worked in the home infusion field for the past 15 years,
serving in various positions throughout the industry including managing several
nationally accredited home infusion companies.
We hope you enjoy learning about pharmaceutical aspects of Myasthenia Gravis and
welcome your comments and suggestions.
Dear Doc,
I just attended a support group for MG and hear other patients talking about IVIG.
What is it? Is it superior to the Mestinon I’m taking now. What does it cost? Does
insurance pay? I live in Glendale.
Intravenous Immunoglobulin (IVIG) is a plasma protein replacement therapy which is
obtained from blood donors. The pooled plasma goes through a rigorous process of
fractionation (obtaining the IgG antibodies from the pooled plasma) and a viral
inactivation process for manufacturing IVIG free of any dangerous pathogens. Once
safely manufactured, it is administered to patients with immune deficiencies and various
autoimmune disorders including Myasthenia Gravis. Even though IVIG is considered an
off-label indication for MG and the cost can be very high, insurance companies are only
authorizing the use of IVIG for patients who develop a myasthenic exacerbation such as
acute respiratory failure, difficulty in swallowing or any major functional disability
responsible for the discontinuation of physical activity. Until more studies are conducted
to determine the effectiveness of IVIG in the long term treatment of MG, it will be very
important for patients to work closely with their physicians and stay compliant with their
current therapies to prevent any exacerbations of their condition.
Dear Doc,
I take Mestinon every four hours and it helps my MG but it destroys my stomach. Any
recommendations? I don’t want to take anything that will interfere with the Mestinon or
that will exacerbate my MG. Are over the counter drug a possibility?
Mestinon is a cholinesterase inhibitor that is used to prevent acetylcholine breakdown
which allows accumulation of acetylcholine for higher transmission of nerve impulses
across neuromuscular junctions. Typically patients tend to experience diarrhea, nausea
and abdominal cramps when they are initiated on Mestinon. Side effects will usually
resolve over time as long as you are very compliant with your dosing protocol. If you
tend to have gastrointestinal (GI) side effects that persist, many physicians will prescribe
propantheline (Pro-Banthine) along with Mestinon to counter the side effects.
Propantheline is an anticholinergic agent which works on the muscarinic receptors of the
GI tract that reduce GI spasms by relaxing the smooth muscle in your gut. Even though it
is an anticholinergic agent, do not be concerned because the low doses prescribed by your
physician do not affect the nicotinic receptors which are involved in muscle contraction.
As for over the counter drugs, (OTC) loperamide (Imodium) is considered a safe
medication for controlling diarrhea. Other OTC’s to consider would be an H-2 Blocker
such as ranitidine (Zantac) or famotidine (Pepcid) and the following Proton Pump
Inhibitor omeprazole (Prevacid OTC). Even though H-2 blockers and PPI’s are used
more traditionally for treatment of reflux, stomach ulcers and heartburn there may be
some beneficial effects for short term use.
Dear Doc,
Maybe it’s the prednisone, but I have a hard time falling asleep. I’m fine once I’m asleep
and rarely awaken in the night. Also, during the day I often feel jittery and nervous. I’m
losing weight even though everyone tells me you are supposed to gain on prednisone.
Please advise.
Some of the common side effects of long term corticosteroid therapy are insomnia, mood
swings, irritability and an increase in anxiety. The exact cause of these side effects are not
known but some researchers believe that prednisone breaks down muscle and releases
glucose in to your system and the higher than normal level of glucose in your system may
create some of those adverse effects. When I counsel patients who are about to start
taking prednisone, I warn them to be prepared for these side effects. Informing family
members would be very beneficial so they understand it is of no fault of yours or theirs. If
these side effects persist, contact your physician regarding possible dosing adjustments or
prescribing a medication to help with your insomnia or anxiety. For many patients taking
prednisone, weight loss may occur but it tends to vary from patient to patient. The
reasons for the weight loss may be due to a decrease in muscle mass and a decrease in
bone density. Prednisone can break down the proteins used to build muscle and that
tends to create a loss of muscle mass in patients. Exercise is an excellent way to maintain
your muscle tone along with a diet higher in protein because the extra protein can be used
to develop more muscle. Always consult with your physician or a nutritionist for the
proper amount of protein required in your daily diet. If you are taking prednisone on a
long term basis speak with your physician about having a bone density test performed as
a baseline because of the increased chance of developing osteoporosis. Talk to your
physician or nutritionist about taking calcium supplements or modifying your diet with
more calcium intake. Also include exercise with weight bearing routines to maintain your
bone strength.
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