SPECIAL CONSIDERATIONS IN LEMS
Because Lambert-Eaton myasthenic syndrome (LEMS) affects both the autonomic and neuromuscular systems, there are several specific treatment considerations to take into account when prescribing therapy for patients.
DRUG-DISEASE INTERACTIONS
Keep these potential drug-disease interactions in mind when recommending or prescribing medicines for conditions beyond LEMS
Vasodilators and anesthesia induction agents may cause exaggerated hypotension in patients with LEMS-related autonomic dysfunction35
Beta-blockers and some antiarrhythmics (eg, quinine, quinidine, procainamide) affect neuromuscular transmission and can exacerbate symptoms of muscle weakness in patients with LEMS36
Isolated instances of exacerbation of LEMS symptoms have been reported after administration of magnesium and intravenous iodinated radiographic contrast dyes36
Certain antibiotics, such as aminoglycosides, fluoroquinolones, and erythromycin, confer significant neuromuscular blocking effects and should be avoided in LEMS patients36-39
SURGICAL CONCERNS
Anesthesia and LEMS
Avoid neuromuscular blocking agents (NMBAs) unless absolutely necessary; if necessary, use only small, titrated doses35
- LEMS patients are highly sensitive to both nondepolarizing and depolarizing NMBAs35,40
Patients undergoing surgery should continue LEMS treatment up until the time of surgery
- Respiratory insufficiency has been reported in patients taking neuromuscular blocking agents prior to surgery35
