Riluzole (Rilutek)
Related Subjects:
|Motor Neuron Disease (MND-ALS)
📌 Riluzole modestly prolongs survival, by about 2–3 months on average, or time to tracheostomy/ventilation in MND (ALS). It does not improve strength or function. People over 75 and advanced disease were under-represented in the trials, and they did not measure quality of life or survival beyond 18 months.
📖 About
- The only disease-modifying drug for MND recommended by NICE (TA20); initiated by a specialist (neurologist), continued under shared care.
- Generic tablets are now available.
- Always check the BNF for up-to-date prescribing information.
⚙️ Mode of Action
- Blocks tetrodotoxin-sensitive voltage-gated sodium channels and inhibits presynaptic glutamate release.
- Reduces glutamate-mediated excitotoxicity in motor neurons.
🎯 Indications
- Amyotrophic lateral sclerosis (ALS) form of motor neurone disease, to extend life or time to mechanical ventilation.
- Not routinely used in progressive muscular atrophy or primary lateral sclerosis (slower, different trajectory - specialist decision).
💊 Dose
| Preparation | Dose |
|---|
| Tablets (adult) | 50 mg twice daily, taken at the same times each day (1 hour before or 2 hours after food reduces nausea and maximises absorption) |
| Oral suspension or orodispersible film | Equivalent dose - useful with dysphagia or PEG feeding |
🧪 Monitoring (BNF)
- LFTs before starting, then monthly for the first 3 months, every 3 months for the rest of the first year, then periodically.
- Stop if ALT >5× ULN.
- FBC if the patient develops a febrile illness - stop if neutropenia is confirmed.
- Ask about cough or breathlessness (rare interstitial lung disease - stop and investigate).
🔄 Interactions
- CYP1A2 inhibitors (fluvoxamine, ciprofloxacin) ↑ levels; inducers (smoking, rifampicin, omeprazole) ↓ levels.
- Additive hepatotoxicity with other hepatotoxic drugs.
⚠️ Cautions
- History of abnormal LFTs or liver disease.
- Renal impairment (limited data).
- May cause dizziness/somnolence - driving advice.
🚫 Contraindications
- Hepatic disease or baseline transaminases >3× ULN.
- Pregnancy and breastfeeding.
💥 Side Effects
- Very common: nausea, asthenia, raised ALT.
- Common: headache, dizziness, somnolence, oral paraesthesia, abdominal pain, vomiting, diarrhoea, tachycardia.
- Uncommon/rare: neutropenia, anaemia, pancreatitis, hepatitis, interstitial lung disease, anaphylaxis.
📚 References
