Fluoroquinolones could impact the amplitude of the miniature endplate potential and current (MEPP and MEPC) by either a presynaptic or a postsynaptic mechanism. proteins. The incidence and prevalence rates of MG are estimated at 0.3C2.8 and 5.35C35 per 100,000, respectively . Onset of MG symptoms in females peaks in the third decade, whereas there is a bimodal male distribution with peaks in the third and sixth decades [2,3]. MG is usually characterized by fatigue and fluctuating ptosis, diplopia, weakness of facial muscle tissue, arms, legs, truncal and respiratory muscles. The symptoms may be localized to certain muscle groups CHUK such Topotecan HCl (Hycamtin) as those controlling the extraocular movements and eyelid elevation (ocular MG) or have a more generalized involvement of multiple groups of muscle tissue (generalized MG). The weakness is generally symmetric (except for symptoms related to the eyes which is often asymmetric) and has more proximal than distal muscle mass involvement . Fluctuation of the weakness is the hallmark of MG. MG is typically diagnosed with a detailed neurological examination, laboratory and/or electrodiagnostic screening. Approximately 85% of patients with generalized MG have AChR antibodies and approximately 40% who are seronegative for AChR-Abs are positive Topotecan HCl (Hycamtin) for muscle-specific tyrosine kinase (MuSK) antibodies [2,5,6]. Antibodies against lipoprotein-related protein 4 (LRP4), cortactin and agrin have also been found to be associated with Topotecan HCl (Hycamtin) MG [5,7,8,9]. A number of medications precipitate autoimmunity and therefore symptomatic MG; many more drugs adversely impact the neuromuscular junction transmission and have been implicated in worsening of MG symptomatology, including precipitation of MG crisis, or unmasking of a previously undiagnosed MG. Awareness of a possibility of a drug-related MG exacerbation is very important as the conversation may result in severe morbidity and potentially a fatal end result. You will find two general mechanisms for a drug to cause MG or MG-like symptoms: 1. Eliciting an autoimmune reaction against the neuromuscular junction; such drugs include immune checkpoint inhibitors, which are progressively utilized for the treatment of malignancy, interferons, and tyrosine kinase inhibitors; and few reports of statins, chloroquine and lithium. The aforementioned drugs can cause de novo MG, or cause exacerbation in a patient with pre-existing MG. 2. Drugs interfering with neuromuscular transmission may result in exacerbation or unmasking of MG symptoms  (Physique 1). As neuromuscular transmission has a high security factor under normal circumstances, drugs that impair neuromuscular transmission generally cause symptoms only when the security factor is usually significantly reduced, such as in active MG, presence of hypocalcemia, hypermagnesemia, concomitant use of muscle mass relaxants used during anesthesia; or when the drug is administered in high doses or its level is usually high such as in renal failure . In this review, we divided the drugs to Topotecan HCl (Hycamtin) two groups: those that cause de novo MG (Table 1) and those that may cause deterioration of MG symptoms and cause MG-like symptomatology in non-MG patients (Table 2). Some drugs take action through both mechanisms, and in some the underlying pathogenesis is not known. We have tried not to include or have limited discussing drugs which are no longer Topotecan HCl (Hycamtin) available for clinical use. We used the adverse drug reaction (ADR) probability scale, as explained by Naranjo et al. , to estimate probability of a causal relation between emergence or deterioration of MG and administration of a drug. For the sake of simplicity, we only included drug groups and not individual drugs and did not list certain categories for which.