Alcohol and myasthenia gravis

The relationship between alcohol and myasthenia gravis (MG) is complex and variable. People with the neuromuscular condition should be aware of how drinking may affect their symptoms and interact with their treatments.

MG is an autoimmune disorder that causes symptoms of muscle weakness and fatigue. It occurs when the immune system mistakenly attacks proteins involved in nerve-muscle communication.

Alcohol’s effects on MG symptoms depend on the individual, although heavy use is generally harmful to overall health. Alcohol may also interact with certain MG medications. After their diagnosis, people with MG should talk with their doctors about whether and how much alcohol is safe for them.

Is alcohol safe with myasthenia gravis?

There is no strong evidence that alcohol worsens MG progression or is inherently unsafe for people living with the disease.

Biologically, alcohol may affect systems relevant to MG, including:

• Immune system: Research suggests that mild or moderate alcohol use may reduce some autoimmune activity, although this is not established in MG, and alcohol has general immune-suppressing effects that can have other negative consequences. Heavy drinking has pro-inflammatory effects and may contribute to symptom flares.
• Nervous system: Alcohol slows, or depresses, brain activity and can cause nerve damage when used in excess. It can also interfere with typical activity at sites of nerve-muscle communication, where MG-related problems also occur.

Everyone’s response to alcohol is different. Whether someone can drink alcohol with MG safely will depend on their medications, how alcohol affects their symptoms, and other health concerns. Occasional drinking may be fine for some individuals with neuromuscular disorders, but chronic, heavy alcohol use and binge drinking are not safe.

Even for people who sometimes drink, doctors may advise avoiding alcohol entirely in certain situations, including:

• during periods of worsening symptoms, known as flare-ups or exacerbations, especially if alcohol is a known trigger
• while on intensive immune-suppressing therapy, because of the risk of side effects

Healthcare providers can help people with MG understand how alcohol may affect them and provide practical MG self-care tips related to alcohol consumption.

How alcohol can affect symptoms

There is no single relationship between alcohol and MG symptoms, but for some people, certain symptoms could worsen after drinking. It is difficult to predict how each person’s symptoms will respond, and there is little academic research on the subject.

MG symptoms that could be affected by alcohol include:

• muscle weakness
• fatigue
• breathing difficulties

Chronic overuse of alcohol can affect muscle strength, while shorter-term, moderate drinking may not directly affect muscles, though the exact relationship between alcohol and MG muscle weakness is not well established. The effects of inebriation, including dizziness and impaired decision-making skills, can increase the risk of falls and accidents for people with existing muscle weakness.

Alcohol is a sedative, and drinking makes many people feel sleepy. On the other hand, drinking before bed may disrupt sleep patterns, which can worsen fatigue for people with MG.

Because of the effects of alcohol on nerve function, heavy alcohol use can slow breathing, potentially worsening MG-related breathing problems.

There are various possible triggers of MG symptoms, which vary between individuals and may include alcohol. If alcohol has been identified as an MG flare trigger in the past, patients should be particularly careful with consumption. Alcohol can also contribute to dehydration, which may trigger MG symptoms for some people.

Alcohol and medications

Some treatments used for managing MG symptoms daily may interact unsafely with alcohol. People living with MG should always talk to their doctors about alcohol interactions with MG medications when starting a new treatment or changing doses.

In particular, people taking corticosteroids or other immunosuppressants may need to take extra care around drinking. Drinking while taking corticosteroids could add to certain side effects or risks, including gastrointestinal problems, weight gain, blood sugar changes, and increased infection risk. The safety may also be dose-dependent. Moderate drinking may be safe in some situations, but the risks increase with higher consumption.

With some other immunosuppressants, a major concern is liver damage. Alcohol and certain medications are processed in the liver, so using them together can stress the liver and increase the risk of liver injury.

For certain other medications used to treat MG, including FcRn blockers and complement inhibitors, there are no known major chemical interactions with alcohol; however, alcohol can worsen potential side effects, such as dizziness or nausea.

Individuals undergoing plasma exchange or intravenous immunoglobulin should ask their healthcare providers about MG lifestyle restrictions, including restrictions on alcohol, in the days before and after the procedure.