10.2. Drugs used in neuromuscular disorders
10.2.1. Drugs that enhance neuromuscular transmission
Restrictions:
Restricted to specialist initiation.
Prescribing Notes:
This medication is used for myasthenia gravis. See Pyridostigmine for Myasthenia Gravis Q&A guideline.
10.2.2. Skeletal muscle relaxants
Restrictions: Baclofen injection is restricted to use in specialist units only. Slow withdrawal of baclofen over one to two weeks is recommended.
Prescribing Notes:
Available as quinine sulphate and quinine bisulphate tablets, oral quinine is used primarily for nocturnal leg cramps. Patients should be reviewed regularly to establish benefit.
Restrictions:
Restricted to specialist use for treatment for symptom improvement in adult patients with moderate to severe spasticity due to multiple sclerosis (MS) who have not responded adequately to other anti-spasticity medication and who demonstrate clinically significant improvement in spasticity related symptoms during an initial trial of therapy.
Prescribing Notes:
Patients commencing treatment should be reviewed via a formal assessment conducted by the specialist service at 4 weeks. Treatment should be discontinued at that point if a clinically significant improvement is not seen. Patients should also continue to be reviewed regularly thereafter to ensure continuing benefit.
Restrictions:
Restricted to specialist initiation. Restricted to recommendation by designated specialists.
10.2.3. Other neuromuscular drugs
Restrictions:
Restricted to specialist use for the symptomatic treatment of myotonia in adults with non-dystrophic myotonic disorders.
Prescribing Notes:
For other indications please see section 2.3.2
Restrictions:
Restricted to specialist use only in the treatment of 5q spinal muscular atrophy (SMA) in patients 2 months of age and older, with a clinical diagnosis of SMA type 1, type 2 or type 3 or with one to four SMN2 [survival of motor neuron 2] copies.
Prescribing Notes:
Available via the Ultra Orphan Pathway with reassessment by SMC following 3 years of data collection. Appropriate paperwork needs completing before prescribing to ensure registration on the national risk sharing scheme.
Restrictions:
Restricted to specialist use for treatment of Duchenne muscular dystrophy (DMD) in patients aged 4 years and older.