(FDA approved in bold)

• Lambert-Eaton myasthenic syndrome (LEMS)
  
• Congenital myasthenia gravis (CMG)

• Exact mechanism of action unknown. Enhances release of acetylcholine following a nerve impulse and slows the rates of depolarization and repolarization of muscle cell membranes

• Hours

• Continue to use to reduce symptoms of LEMS or CMG at lowest required dose. Disease-modifying treatments, such as plasma exchange, intravenous immune globulin, corticosteroids, or immunosuppressives are helpful and identifying malignancy such as small-cell lung cancer is essential

• Treat with immunologic therapy
  
• Removal of neoplasm may improve symptoms
  
• Change to 3,4-Diaminopyridine

• May be combined with pyridostigmine, which increases the available amount of acetylcholine for receptor binding which may allow reduction of dose and toxicity

• Obtain baseline CBC and monitor frequently during treatment. Monitor renal function and urinalysis