Comprehensive List of Drugs That Affect Muscles: To be Avoided by People with Periodic Paralysis

Comprehensive List of Drugs That Affect Muscles: To be Avoided by People with Periodic Paralysis

Periodic Paralysis (PP) is a group of genetic disorders characterized by episodes of muscle weakness or paralysis. These conditions include Hypokalemic Periodic Paralysis (HypoPP), Hyperkalemic Periodic Paralysis (HyperPP), and Andersen-Tawil Syndrome (ATS). Certain medications can exacerbate these conditions by affecting muscle function. Below is a comprehensive list of drugs that individuals with PP should avoid or use with caution, along with specific drug names for each category.

Muscle Relaxants and Anesthetics

• Succinylcholine: Can trigger myotonic crises including masseter and laryngospasms, making it contraindicated.
• Non-depolarizing Muscle Relaxants:
• Vecuronium
• Pancuronium
• Atracurium
• Volatile Anesthetics: Generally safe, with some (like propofol) having antimyotonic properties.

Beta-Blockers

• Propranolol: Can exacerbate symptoms in some forms of PP.
• Atenolol
• Metoprolol

Diuretics

• Thiazide Diuretics: Can cause hypokalemia, triggering attacks in HypoPP.
• Hydrochlorothiazide
• Chlorthalidone
• Potassium-Sparing Diuretics: Risk of hyperkalemia in HyperPP.
• Spironolactone
• Amiloride

Antihypertensives

• ACE Inhibitors and ARBs: Monitor potassium levels as they can cause hyperkalemia.
• Lisinopril
• Enalapril
• Losartan

Antibiotics

• Macrolides:
• Erythromycin
• Clarithromycin
• Azithromycin
• Fluoroquinolones:
• Ciprofloxacin
• Levofloxacin

Antipsychotics

• Typical Antipsychotics:
• Haloperidol
• Chlorpromazine
• Thioridazine
• Atypical Antipsychotics:
• Quetiapine
• Olanzapine
• Ziprasidone
• Risperidone

Antidepressants

• Tricyclic Antidepressants (TCAs):
• Amitriptyline
• Doxepin
• Imipramine
• Nortriptyline
• SSRIs:
• Citalopram
• Escitalopram

Antiarrhythmics

• Class IA:
• Quinidine
• Procainamide
• Disopyramide
• Class III:
• Amiodarone
• Sotalol

Antihistamines

• Older Antihistamines:
• Terfenadine (withdrawn)
• Astemizole (withdrawn)
• Other Antihistamines:
• Diphenhydramine

Other Medications

• Antimalarials:
• Chloroquine
• Hydroxychloroquine
• Opioids:
• Methadone
• Other:
• Lithium (used in bipolar disorder)

References

1. Comprehensive list of drugs and conditions causing QT prolongation, torsade de pointes (TdP) and long QT syndrome (LQTS)
2. Drug-Induced QT Prolongation - U.S. Pharmacist
3. Drugs Causing QT Prolongation • LITFL • ECG Library Basics
4. Drugs that prolong the QT interval - North & East
5. New Drug for Periodic Paralysis has Roots in URMC Research | URMC Newsroom
6. Treatment Updates for Neuromuscular Channelopathies | Current Treatment Options in Neurology

Individuals with Periodic Paralysis should always consult with healthcare providers before starting or stopping any medication. Regular monitoring and a personalized treatment plan are crucial for managing these conditions effectively.

Image: Young man in a wheelchair due to weak muscles.