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Diaminopyridine
General information
Diaminopyridine (3,4-diaminopyridine), now also known as amifampridine, blocks calcium-dependent potassium channels and prolongs the duration of the action potential at motor nerve terminals; this enhances calcium influx into nerve endings and causes release of acetylcholine [ ]. It has been used to treat Lambert–Eaton myasthenic syndrome in patients with no other treatment alternatives [ , ]. Adverse reactions that have been reported include anxiety, chorea, seizures, wakefulness, unsteadiness, and blurred vision; perioral and peripheral paresthesia; cough and bronchial hypersecretion; nausea and diarrhea; bouts of palpitation, ventricular extra beats, and cold peripheries.
AFSSAPS, the Regulatory Agency in France has advised health professionals that there is no evidence of the efficacy of 3,4-diaminopyridine in treating fatigue associated with multiple sclerosis [ ].
Drug studies
Placebo-controlled studies
In a placebo-controlled study in 26 subjects with Lambert–Eaton syndrome diaminopyridine produced significantly greater improvement in the quantitative myasthenia gravis (QMG) score and in the summated amplitude of compound muscle action potentials recorded from three sentinel limb muscles [ ]. All but one patient had significant symptomatic improvement from subsequent open-label diaminopyridine. Adverse reactions to diaminopyridine were reportedly negligible, and consisted of perioral and digital paresthesia. There were no effects on laboratory measurements of liver, renal, hematological, or endocrine function and no encephalographic or electrocardiographic effects.
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