Medications for myasthenia gravis (MG) can include cholinesterase inhibitors, corticosteroids, immunosuppressants, monoclonal antibodies, and antibody fragment medications.

While myasthenia gravis is a chronic condition that doesn’t currently have a cure, treatment can improve symptoms and overall quality of life. Medications are often a key part of a treatment plan.

A treatment plan for MG usually involves a combination of approaches such as medications, surgery, and complementary therapies. The exact treatment recommendations are based on your individual symptoms and disease progression.

Keep reading to learn more about medications doctors may recommend for MG.

Also known as anticholinesterases, cholinesterase inhibitors are often considered first-line medications for MG. They tend to work quickly and have fewer long-term side effects than corticosteroids or immunosuppressants.

Cholinesterase inhibitors work by preventing your muscles from breaking down acetylcholine, which is necessary for healthy muscle contractions. As a result, they could increase your muscle strength to help you carry out daily activities.

These medications are available in either liquid or tablet form in a drug called pyridostigmine bromide (Mestinon). The effects last a few hours at a time, which means you may need to take the medication several times per day to manage your MG symptoms.

The drawback to cholinesterase inhibitors is that they address only short-term symptoms. Unlike immunosuppressants, these drugs don’t target MG at its source or prevent further progression of the condition.

Possible side effects

Possible side effects of this type of medication include:

  • muscle cramps
  • muscle twitching
  • unusual sweating
  • diarrhea
  • abdominal cramps
  • nausea
  • increased salivation

It is important to report any concerns to your doctor.

Corticosteroids are common immunosuppressive therapies for conditions such as MG. The main type of corticosteroid for the treatment of MG is prednisone (Deltasone, Prednisone Intensol, Rayos).

Your doctor may recommend that you take this medication every other day at first and then gradually taper off the dosage. The average starting dose is 60 to 100 milligrams.

Possible side effects

As with any medication, corticosteroids can cause side effects. Possible side effects of prednisone can include:

The longer you take prednisone, the greater the risk of side effects will be. For this reason, you’ll likely take this medication for only a short time.

Immunosuppressants work by targeting the cause of MG at its source: your immune system. By suppressing overactivity in your immune system, these medications may help reduce your symptoms and prevent MG progression.

Common immunosuppressants for MG include:

  • azathioprine (Imuran)
  • cyclophosphamide (Cytoxan, Neosar)
  • cyclosporine (Neoral, Sandimmune,)
  • methotrexate (Otrexup, Trexall, Xatmep)
  • mycophenylate mofetil (CellCept)
  • tacrolimus (Prograf)

Immunosuppressants are taken for a longer period of time than corticosteroids. They may not reach full effectiveness until 3 to 6 months after you start taking them.

Possible side effects

Immunosuppressants have some risks, especially when you take them long term, because they also suppress your body’s ability to fight off everyday infections.

A doctor will assess the benefits and possible risks before prescribing these medications and monitor you carefully while you’re taking them.

Side effects can depend on the type of medication. For example, side effects of azathioprine can include:

  • nausea
  • tiredness
  • dizziness
  • joint pain
  • muscle pain
  • easily bleeding or bruising

Your doctor can provide you with more information about the possible side effects of the immunosuppressants they recommend. They’ll also be able to inform you about what to do if serious side effects occur.

Monoclonal antibodies are some of the newest medications used to treat MG.

Eculizumab (Soliris)

Eculizumab helps prevent neuromuscular junction damage. You’ll receive it weekly for 4 weeks, followed by every 2 weeks, and is approved for people who have tested positive for anti-acetylcholine receptor antibodies.

Taking eculizumab may increase your risk for infections. A doctor may recommend that you take preventive antibiotics and make sure you’re up to date on meningococcal vaccinations before starting this medication.

Rituximab (Rituxan)

Rituxan is a type of monoclonal antibody. It suppresses MG activity by targeting B lymphocytes.

You’ll receive rituxan infusions once every 6 months

Like eculizumab, rituximab increases your risk for infections. In particular, the drug increases the risk for sinus and lung infections and reactivated hepatitis B infections.

Rozanolixizumab-noli (Rystiggo)

Rozanolixizumab-noli (Rystiggo) was approved for the treatment of MG in 2023. You’ll receive it under your skin (subcutaneously).

Common side effects include:

  • headaches
  • nausea
  • diarrhea

Antibody fragment infusions

In 2021, the Food and Drug Administration (FDA) approved an antibody fragment medication for MG called efgartigimod (Vyvgart) for treating MG.

Efgartigimod works by lowering anti-acetylcholine receptor antibodies. You’lll receive it as an infusion.

Upon approving the drug, the FDA noted the following side effects:

New drugs are constantly being studied for potential MG treatment.

Researchers are looking at medications that target autoantibodies, which are proteins that attack your immune system.

Additionally, researchers are investigating possible biomarkers of MG. By testing for these biomarkers early, a doctor may be able to find out which classes of medications may or may not work for you.

Aside from medications, you might consider talking with your doctor about other available treatments and strategies for managing MG, such as:

What is the newest medication for myasthenia gravis?

At the time of writing, the newest medication for MG is zilucoplan (Zilbrysq), a daily injection that was approved in October 2023.

What is the first drug for myasthenia gravis?

Pyridostigmine bromide (Mestinon), a type of cholinesterase inhibitor, is usually the first drug doctors prescribe for MG. It helps manage muscle weakness by preventing signal disruptions between your muscles and nerves.

What is the best treatment for myasthenia gravis?

There is no single best treatment for MG, and your treatment plan will be highly individualized.

Depending on the severity of your symptoms and your overall condition, a doctor may first recommend cholinesterase inhibitors, as these have the fewest side effects. However, more severe MG may require long-term treatments such as immunosuppressants.

Doctors may first recommend cholinesterase inhibitors, specifically pyridostigmine bromide, for the treatment of myasthenia gravis (MG).

Other medications that can help treat MG include corticosteroids, immunosuppressants, monoclonal antibodies, and antibody fragment medications.

Your doctor can help you create a suitable treatment plan. Some medications address the condition directly, while others can help manage symptoms.

Your doctor can also make you aware of possible side effects, and what to do if any occur.