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Riluzole: a new agent for amyotrophic lateral sclerosis
1Department of Pharmacy Practice, Rutgers, State University of New Jersey, Piscataway 08855, USA.
The Annals of Pharmacotherapy
|June 1, 1997
Summary
Riluzole may extend survival for amyotrophic lateral sclerosis (ALS) patients, though its benefits and cost are debated. This review covers riluzole
Area of Science:
- Pharmacology and Neurology
- Drug Efficacy and Safety
Background:
- Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disease.
- Riluzole is the only FDA-approved medication for ALS treatment.
Purpose of the Study:
- To comprehensively review riluzole's properties, including mechanism of action, pharmacokinetics, and adverse effects.
- To evaluate the efficacy and administration of riluzole in ALS patients.
- To provide a brief overview of amyotrophic lateral sclerosis (ALS).
Main Methods:
- Computerized MEDLINE database search (May 1996) for publications on ALS and riluzole.
- Inclusion of manufacturer's information when primary literature was unavailable.
- Analysis of data from two clinical trials involving 1114 ALS patients.
Main Results:
- Riluzole demonstrates good oral absorption and extensive protein binding.
- Primary metabolism involves CYP1A2 hydroxylation and glucuronidation, with renal elimination.
- Efficacy trials showed riluzole extended time to tracheostomy or death, but symptom improvement was not observed; trial validity has been questioned. Common side effects include elevated liver enzymes, nausea, and asthenia; neutropenia is a serious but rare adverse event.
Conclusions:
- Riluzole may offer a survival benefit in ALS patients by delaying tracheostomy or death.
- Despite questionable benefits and high cost, riluzole is the sole approved treatment for ALS.
- Availability of riluzole for ALS patients is recommended.