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Low-dose guanidine and pyridostigmine: relatively safe and effective long-term symptomatic therapy in Lambert-Eaton myasthenic syndrome.

Abstract
Guanidine hydrochloride is known to be highly effective in the symptomatic treatment of the Lambert-Eaton myasthenic syndrome (LEMS). However, because of its potentially dangerous side reactions of hematologic abnormalities and renal insufficiency, 3,4-diaminopyridine, which is not readily available in the United States, is recommended as the preferred drug for LEMS. We used low-dose guanidine and pyridostigmine combination therapy in 9 patients with LEMS and analyzed its long-term safety and effectiveness. In all patients, a liberal amount of pyridostigmine was used, while daily guanidine dose was kept below 1000 mg a day, and guanidine was given between pyridostigmine dosings. This combination therapy was used for 3-102 months (mean: 34.1 months) and improved clinical status in all patients. Although guanidine had to be discontinued due to severe gastrointestinal symptoms in 3 cases, no serious side reactions such as bone marrow suppressions or signs of renal insufficiency developed in any case. Thus, we conclude that low-dose guanidine therapy is relatively safe and effective for long-term symptomatic treatment of LEMS when it is combined with pyridostigmine.
AuthorsS J Oh, D S Kim, T C Head, G C Claussen
JournalMuscle & nerve (Muscle Nerve) Vol. 20 Issue 9 Pg. 1146-52 (Sep 1997) ISSN: 0148-639X [Print] UNITED STATES
PMID9270671 (Publication Type: Clinical Trial, Journal Article)
Chemical References
  • Cholinesterase Inhibitors
  • Guanidines
  • Guanidine
  • Pyridostigmine Bromide
Topics
  • Adult
  • Aged
  • Cholinesterase Inhibitors (administration & dosage, adverse effects, therapeutic use)
  • Dose-Response Relationship, Drug
  • Electrophysiology
  • Female
  • Guanidine
  • Guanidines (administration & dosage, adverse effects, therapeutic use)
  • Humans
  • Lambert-Eaton Myasthenic Syndrome (complications, drug therapy, physiopathology)
  • Male
  • Middle Aged
  • Neoplasms (complications, therapy)
  • Pyridostigmine Bromide (administration & dosage, adverse effects, therapeutic use)
  • Time Factors
  • Treatment Outcome

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