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1. Excessive anticholinergic medication resulting in weakness
Cholinergic crisis is a rare, but potentially major, side effect of excessive anticholinergic medication characterized by weakness. It may be difficult to distinguish this paradoxical weakness caused by the anticholinergic medication from the worsening myasthenia syndrome itself. Cholinergic crisis is rarely seen when the dosing limitation of pyridostigmine are followed: <120mg every 3 hours OR <960 mg total daily dose. If these parameters are followed and the patient continues to have severe weakness, it is reasonable to assume that the MG is worsening.
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