Riluzol

Riluzol, also known as riluzole, is a prescription medication used to treat amyotrophic lateral sclerosis (ALS). It is considered a disease-modifying therapy and is among the few drugs that have been shown to modestly extend survival and slow functional decline in ALS.

The exact mechanism of action is not fully understood, but riluzol is described as a glutamate-modulating agent. It is thought to reduce excitotoxic neuronal injury by multiple actions, including inhibition of glutamate release, blockade of voltage-gated sodium channels, and enhancement of astrocytic uptake of glutamate. These effects are believed to contribute to its neuroprotective profile in motor neuron disease.

Riluzol is typically prescribed as 50 mg taken orally twice daily. It is advised to take the medication on an empty stomach, avoiding fatty meals near dosing to optimize absorption. Dosing may be adjusted or interrupted based on tolerability and liver function. Patients generally require periodic liver function tests, as riluzol can cause elevations in hepatic enzymes and, rarely, more serious liver injury. The drug can interact with other medications that affect liver enzymes, so clinicians review concomitant therapies.

Clinical trials in ALS have shown a modest improvement in survival, with additional benefit on slowing the decline of physical function in some patients. The overall effect is small and varies among individuals, and riluzol does not reverse disease progression. It is approved in many countries, including the United States since 1995, and is available in generic forms in some markets.

Common side effects include fatigue, dizziness, nausea, and elevated liver enzymes. More serious adverse events are uncommon but can occur, underscoring the importance of medical supervision and regular liver monitoring during riluzol therapy.