Which drug is often used as a first-line treatment for patients with myasthenia gravis experiencing acute exacerbations?

Neostigmine is commonly used as a first-line treatment for patients with myasthenia gravis who are experiencing acute exacerbations. This medication is a reversible acetylcholinesterase inhibitor, which enhances the concentration of acetylcholine at the neuromuscular junction by preventing its breakdown. In myasthenia gravis, there is a reduction in the number of available acetylcholine receptors due to antibody-mediated destruction; thus, increasing acetylcholine levels helps improve communication between nerves and muscles, alleviating symptoms such as muscle weakness and fatigue.

Neostigmine has rapid onset and can be administered through various routes, including oral and injectable forms, making it effective during acute situations. The action of neostigmine is beneficial for quickly managing the debilitating symptoms of myasthenia gravis, especially during exacerbations when patients might experience increased muscle weakness.

Other drugs, while potentially relevant to symptom management in myasthenia gravis, may not be as effective during acute exacerbations or may have different primary uses. For example, pyridostigmine, although also an acetylcholinesterase inhibitor, is typically used for long-term management rather than acute treatment. Rivastigmine is primarily used for Alzheimer’s disease