Medical Drug Alert

Muscular Dystrophy & Neuromuscular Disorders Drugs to be avoided or used with caution

This list comprises drugs and pharmaceuticals known to cause problems, in some cases significant negative outcomes for a person affected by Muscular Dystrophy or a Neuromuscular Disorder (NMD) and these should be avoided.

If you are undertaking a procedure or treatment, it would be wise to alert your treating doctor, surgeon or other health professional to this list.

As new risks are identified and applicable to MD / NMD, this list shall be updated to reflect the inclusion of that pharmaceutical agent.

Charcot Marie Tooth – CMT:

Amiodarone (Cordarone)
Cisplatin & Oxaliplatin
Cytarabine
Ethambutol
Etoposide (VP-16)
Griseofulvin
Hydrallazine
Metronidazole / Misonidazole
Nitrofurantoin (Macrodantin Furadantin Macrobid)
Nitrous Oxide (inhalation abuse or, Vitamin B12 deficiency)
Penicillamine
Perhexiline
Vincristine
Taxols

Duchenne muscular dystrophy

These can predispose the patient withDMD to anaesthesia-induced rhabdomyolysis
Anaesthetic agents:
Neuromuscular blocking agents especially:
Suxamethonium / Succhinylcholine
Vecuronium
Botulinum toxin

Facioscapulohumeral – FSHD

Medical treatments for FSHD are relatively few, and none are specific to FSH. There’s no treatment that can halt or reverse the effects of FSHD, but
there are treatments and devices to help alleviate many of the symptoms.
However persons with FSHD who need to undergo anaesthesia should ensure that their anaesthetist is aware of their diagnosis. Respiratory muscle involvement in this condition can be under-recognised and may lead to unexpected hypersensitivity to sedative medications. This may in
some cases lead to respiratory suppression.

Myasthenia gravis – MG

Anaesthetic agents:
Neuromuscular blocking agents especially:
Suxamethonium / succhinylcholine
Vecuronium
Botulinum toxin
Antibiotics:
Aminoglycosides:
Gentamycin
Kanamycin
Neomycin
Netilmicin
Streptomycin
Tobramycin
Fluoroquinolones:
Ciprofloxacin
Gatifloxacin
Norfloxacin
Ofloxacin
Tetracyclines:
Clindamycin
Sulfonamides
Penicillins – considered safe.
Macrolides:
Arithromycin
Clarithromycin
Quinolones:
Chloroquine
Quinidine
Quinine
Beta blockers:
Atenolol
Labetalol
Maleate eyedrops
Metoprolol
Nadolol
Oxprenolol
Practolol
Propanolol
Timolol
Anticonvulsants:
Barbiturates
Ethosuximide
Gabapentin
Phenytoin
Calcium channel blockers:
Verapamil
Iodinated contrast agents (a form of X-ray dye)
Other cardiac drugs:
Bretyllium
Ophthalmologic: Timolol
Procainamide
Psychiatric:
Amitriptyline
Amphetamines
Haloperidol
Lithium
Phenothiazines
Drugs known to cause myasthenia:
D-penicillamine

Myotonic muscular dystrophy

The patient with myotonic dystrophy is at increased risk from anaesthesia and has abnormal sensitivity to drugs which decrease respiratory drive (barbiturates and morphine). Abnormalities in the respiratory system leads to excessive sleepiness and sensitivity to sedation.
Avoid:
Amitriptyline
Digoxin
Procainamide
Propranolol
Quinine
Sedatives
Cholesterol-lowering medications (i.e., statins), can cause muscle pain and weakness in persons with myotonic dystrophy.