Mrs. Manel Rodrigo

Female · 72 years · Sri Lanka
Last updated: 2026-05-09
Notice to any new prescriber: Multiple chronic conditions and several interacting medications. Review the Medications and Cautions tabs before prescribing.
Stable, monitored

Chronic Kidney Disease — Stage 2

One kidney enlarged, the other shrunk to ~20% function. The functional kidney carries the full load.

Serum creatinine within normal range; eGFR slightly reduced.

Diagnosed: many years ago

Post-surgical, on maintenance

Glaucoma — both eyes

Trabeculectomy × 2 (both eyes). Cataract surgery × 2 (both eyes).

On topical steroid drops for IOP control.

Diagnosed after CKD

Controlled, tapering

Myasthenia Gravis — generalised

Began as ocular, progressed to generalised, now fully controlled.

On Mestinon, Cortivex (corticosteroid), MMF. Tapering.

Diagnosed: 2025

Controlled, tapering

Hyperthyroidism (retrosternal goitre)

Long-suspected; formally diagnosed after the myasthenia work-up.

On Carbimazole, tapering. TSH within normal range.

Diagnosed: 2025

Newly diagnosed (May 2026)

Female pattern hair loss (FPHL)

Trichoscopy: FPHL with possible drug-induced aetiology (suspected MMF and/or carbimazole).

Bloods: TSH, FBC, vit D, B12 within normal limits.

Diagnosed: 2026-05-06

Drug For Dose / Schedule Status Notes
Mestinon (pyridostigmine) Myasthenia gravis TBC Maintenance Cholinergic. GI cramps, bradycardia possible at higher doses.
Cortivex (corticosteroid — verify formulation) Myasthenia gravis TBC · tapering Tapering Long-term steroid — monitor IOP (glaucoma), bone density, glucose.
MMF (mycophenolate mofetil) Myasthenia gravis TBC Maintenance Immunosuppressant. Monitor FBC. Avoid live vaccines. Possible contributor to current hair loss.
Carbimazole Hyperthyroidism TBC · tapering Tapering Risk of agranulocytosis — sore throat / fever → urgent FBC. Stacks with MMF for marrow suppression risk.
Antihypertensive (drug TBC) Hypertension / CKD TBC Maintenance Confirm class — ACEi/ARB requires renal monitoring given CKD.
Statin (drug TBC) Cholesterol TBC Maintenance Some statins can rarely worsen myasthenia — flag any new muscle weakness.
Topical steroid eye drops (drug TBC) Glaucoma / IOP control TBC Maintenance Confirm exact agent; topical steroids can themselves raise IOP long-term.
Trichoshul (oral hair supplement) Hair loss (FPHL) 1 tablet daily × 6 weeks New — 2026-05-06 Vitamin / mineral combination supplement.
Minoxidil 5% topical (Minex / Mino 5) Hair loss (FPHL) Apply to scalp each morning New — 2026-05-06 Mild systemic absorption possible — can lower BP slightly. Monitor with antihypertensive.
Beprosalic lotion (betamethasone + salicylic acid) Hair loss (FPHL) Apply to scalp at night (nocte) New — 2026-05-06 Topical steroid — minimise contact with eyes/face given glaucoma. Adds to overall steroid load.

Drugs to avoid or use with caution

Avoid — can worsen myasthenia gravis
  • Aminoglycosides (gentamicin, amikacin, tobramycin, neomycin) — also nephrotoxic
  • Fluoroquinolones (cipro-, levo-, moxifloxacin)
  • Macrolides (azithro-, clarithro-, erythromycin) — caution
  • Telithromycin — absolutely avoid
  • Beta-blockers, including topical eye drops (timolol, betaxolol)
  • IV / high-dose magnesium; quinine, quinidine, procainamide; botulinum toxin; D-penicillamine
Avoid — nephrotoxic / unsafe in CKD
  • NSAIDs (ibuprofen, diclofenac, naproxen, mefenamic acid, etoricoxib) — she has only one functional kidney
  • IV iodinated contrast — risk-benefit only, with hydration — also affects thyroid
  • Lithium; dose-adjust antibiotics, antivirals, gabapentin, metformin, allopurinol for renal function
Caution — can worsen glaucoma
  • Anticholinergics: oxybutynin, hyoscine, tricyclics, some antihistamines — also worsen MG
  • Topiramate, sulfa drugs — angle closure risk
  • Sympathomimetics (pseudoephedrine, decongestants)
  • Systemic / topical steroids raise IOP — she is already on both.
Caution — thyroid / blood-count
  • Iodine-containing contrast / supplements; amiodarone
  • Other marrow-suppressing drugs — stack on MMF + carbimazole
  • Live attenuated vaccines — avoid while on MMF

Cross-effects worth flagging at every visit

  • Steroids vs glaucoma: systemic Cortivex + new topical Beprosalic both add to intraocular-pressure load.
  • Glaucoma drops vs MG: beta-blocker eye drops (most common class) can worsen MG — ophthalmologist must pick a non-beta-blocker option.
  • MMF + Carbimazole: both can suppress bone marrow. Regular FBC; sore throat / fever / unexplained bruising = urgent FBC.
  • Suspected drug-induced hair loss: dermatologist flagged MMF / carbimazole as likely contributors. Do not stop either — trade-off discussion with neurologist + endocrinologist.
  • Topical minoxidil + antihypertensive: minoxidil can mildly lower BP — recheck after 2–4 weeks of starting.
  • One functional kidney: any drug needing renal dose adjustment must be adjusted from baseline. Avoid nephrotoxic drugs entirely if alternatives exist.
  • Imaging: avoid iodinated contrast where possible — bad for both kidney and thyroid.

Care team

  • General Practitioner TBC
  • Nephrologist TBC
  • Ophthalmologist (glaucoma) Dr Imalka Fonseka
  • Neurologist (myasthenia) Dr Kishara Gooneratne
  • Endocrinologist (thyroid) Dr Nipun de Silva
  • Dermatologist Dr Chathurarya Siriwardena

Surgical history

  • Trabeculectomy Both eyes — for glaucoma
  • Cataract surgery Both eyes

Recent labs

  • eGFR Stage 2 (slightly reduced) — date TBC
  • Serum creatinine Within normal range — date TBC
  • TSH Normal — 2026-05
  • FBC, vitamin D, vitamin B12 Normal — 2026-05

Allergies & intolerances

No known drug allergies recorded. Confirm and update.