Antipsychotic Selection in Myasthenia Gravis

Key Principles for Management

The American College of Physicians recommends assessing baseline disease stability, evaluating current symptom control, respiratory function, and bulbar function before initiating any antipsychotic, with a strength of evidence level of high 1
The American Academy of Neurology suggests consulting neurology before starting treatment to determine the safest option and establish a monitoring plan, with a strength of evidence level of moderate 1
Intensive monitoring for worsening muscle weakness, respiratory compromise, changes in speech or swallowing, and need for rescue therapy is crucial when using antipsychotics, with a strength of evidence level of high 1

Monitoring for increased fatigable weakness, particularly proximal muscle groups, is essential when using antipsychotics, with a strength of evidence level of moderate 1
Regular assessment of respiratory function with pulmonary function tests is necessary, with a strength of evidence level of high 2, 3
Watching for worsening ocular symptoms and bulbar symptoms is vital when using antipsychotics, with a strength of evidence level of moderate 1

Optimizing MG treatment first, such as using pyridostigmine, corticosteroids, and immunosuppressants, can help maximize disease stability before introducing psychiatric medications, with a strength of evidence level of moderate 1
Having rescue therapy readily available, such as IVIG or plasmapheresis, is crucial in case of severe exacerbation, with a strength of evidence level of high 2, 3