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International Alliance of ALS/MND Associations

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Riluzole/Tiglutik

Background

Riluzole is a drug used to treat people with Amyotrophic Lateral Sclerosis (ALS) or Motor Neuron Disease (MND). Riluzole is not a cure for ALS/MND, but it may extend survival or time until tracheostomy. It is available in three dosage forms: tablet, oral suspension, and thin film.

The tablet form, Rilutek, was approved by the Food and Drug Administration (FDA) in USA in 1995 and by the European Medicine Agency (EMA) in Europe in 1996.

The oral suspension form, Tiglutik or Teglutik, which is designed for people living with ALS/MND who have difficulty swallowing tablets, is currently approved in many countries including USA, Canada, Europe, Israel, Australia, Brazil, Japan, and China.

The thin film form is available in the US (with the commercial name of Exservan), and in the UK and the EU (with the commercial name of Emylif).

Proposed Mechanism of Action

Neurons have a finely regulated system that allows chemical signals (neurotransmitters) to be translated into electrical signals, which travel much faster and allow efficient communications among neurons. This mechanism is essential for the correct functioning of the human brain, and it is particularly important for motor neurons, which are among the largest neurons in the central nervous system.

ALS/MND is characterized by a progressive and selective death of motor neurons, the causes of which are mostly unknown. One of the mechanisms thought to be involved in this process is excitotoxicity, which occurs when neurons are exposed to excessive levels of a neurotransmitter called glutamate, causing a dysregulated neuronal activation. This may lead to neuronal damage and eventual death.

Riluzole was the first compound ever approved for the treatment of ALS/MND. Riluzole’s mechanism of action is not fully understood; however, it is thought to interfere with the excessive glutamate release that leads to excitotoxicity in ALS/MND.

Of note, other clinical trials in people living with ALS/MND with compounds that have a similar mechanism of action have failed. Therefore, riluzole’s action has been hypothesized to expand to other aspects of neurotransmission or even other molecular mechanisms linked to ALS/MND. These hypotheses are currently under investigation.

Clinical Trials

Riluzole was approved based on two international clinical trials that included a total of 1,114 people living with ALS/MND (PALS).

In the first study, 155 PALS were treated with 100 mg of riluzole or placebo daily for 12 months. By the end of the study, the treatment extended survival or time until tracheostomy (where a breathing tube is inserted directly into the throat) by roughly three months compared to placebo.

In the second study, 959 PALS were treated with three different concentrations of riluzole (50 mg, 100 mg, 200 mg) or placebo daily for 18 months. Both the 100 mg and 200 mg treatments extended survival or showed significant delay in the need for tracheostomy when compared to placebo. However, the 200 mg dose resulted in more side effects.

Dose and Administration

Riluzole comes in three forms and has several brand names:

  • Tablet form: Rilutek contain 50 mg of the active compound (riluzole). The recommended dose is 50 mg twice daily (every 12 hours) taken orally.
  • Oral suspension form: Tiglutik or Teglutik is recommended for patients who have difficulty in swallowing or receive nutrition via feeding tube. The dosage recommendation is the same as Rilutek. The FDA approved Tiglutik in 2018, whereas Teglutik has been available in the UK since 2015.
  • Thin film form: Exservan/Emylif dissolves on the tongue. It is applied one to two hours prior to a meal.

Riluzole is recommended for all patients diagnosed with ALS/MND. However, due to lack of studies, it is unclear whether it is equally effective after five years from symptom onset.

Reported Side Effects

Riluzole is safe and generally well tolerated at a dose of 100 mg daily for up to seven years. The most common side effects are numbness around the mouth, nausea, dizziness, diarrhea, lack of energy, high blood pressure, decreased lung function, and abdominal pain. Rare cases have reported liver injury.

In 2020, a study showed that out 15 peer-reviewed studies in PALS treated with riluzole in real-world settings, eight found that survival was a median of 6 to 19 months longer on riluzole than on placebo. Riluzole’s effects and safety continue to be investigated in people living with ALS/MND.

Riluzole should be administered and monitored under the care of a physician.

Disclaimer: Consult with your doctor to determine if riluzole is an option for you. Always disclose your medical history, including any drugs, natural supplements, or herbal medicines you are currently using. Your doctor will determine the right plan for your needs.

SOURCES

  • https://www.ajmc.com/view/diseasemodifying-treatment-of-amyotrophic-lateral-sclerosis
  • https://www.sciencedirect.com/science/article/abs/pii/S0028390820300526?via%3Dihub
  • https://go.drugbank.com/drugs/DB00740
  • https://pubmed.ncbi.nlm.nih.gov/16806844/ 
  • https://www.nejm.org/doi/full/10.1056/NEJM199403033300901#t=article 
  • https://www.sciencedirect.com/science/article/abs/pii/S0140673696916803 
  • https://alsnewstoday.com/rilutek-riluzole-for-als/#Clinical_trials

The original language of communication is English and any translation cannot be guaranteed for accuracy of messaging.

Primary Sidebar

Approved Drugs

  • Nuedexta
  • Radicava/Edaravone
  • Riluzole/Tiglutik
  • Rozebalamin/Methylcobalamin
  • Tofersen/Qalsody

  • Charlie “Hark” Dourney, Diagnosed 2007 , Hark ALS, USA

    Charlie “Hark” Dourney, Diagnosed 2007 , Hark ALS, USA

  • Chen Chun-Chin

    Chen Chun-Chin

  • Jose Rivero Muñoz, Diagnosed 2015, FYADENMAC, Mexico

    Jose Rivero Muñoz, Diagnosed 2015, FYADENMAC, Mexico

  • Teddy Hanono Annie, Apoyo Integral Gila A.C., Diagnosed 2018, Mexico

    Teddy Hanono Annie, Apoyo Integral Gila A.C., Diagnosed 2018, Mexico

  • Marcelo Farinelli, Diagnosed 2006, ABrELA, Brazil

    Marcelo Farinelli, Diagnosed 2006, ABrELA, Brazil

  • Bruno Leanza Mantegna, Diagnosed 1999 , AISLA Onlus, Italy

    Bruno Leanza Mantegna, Diagnosed 1999 , AISLA Onlus, Italy

  • Peng Yi-Wen

    Peng Yi-Wen

  • Shay Rishoni, Diagnosed 2011 , Prize4Life, Israel

    Shay Rishoni, Diagnosed 2011 , Prize4Life, Israel

  • Chih Ching Darren Wong, MND Malaysia

    Chih Ching Darren Wong, MND Malaysia

  • Kirsten Harley,  Diagnosed 2013,  Australia

    Kirsten Harley, Diagnosed 2013, Australia

  • Cath Muir

    Cath Muir
    Cath

  • Cassio Fernando da Silva, Diagnosed 2013 , ABrELA, Brazil

    Cassio Fernando da Silva, Diagnosed 2013 , ABrELA, Brazil

  • Dorette Lüdi, Diagnosed 2014 , ALS Schweiz, Switzerland

    Dorette Lüdi, Diagnosed 2014 , ALS Schweiz, Switzerland

  • Sam Hayden-Harler, Motor Neurone Disease (MND) Association, UK

    Sam Hayden-Harler, Motor Neurone Disease (MND) Association, UK

  • Jan Zuring, Diagnosed 2010 , The Netherlands

    Jan Zuring, Diagnosed 2010 , The Netherlands

  • Fabrice Kamp, Germany

    Fabrice Kamp, Germany

  • Emilienne Verhaegen, ALS Liga Belgium, Diagnosed 2014

    Emilienne Verhaegen, ALS Liga Belgium, Diagnosed 2014

  • Susan Anderson, Diagnosed 2014 , Hope Loves Company,  USA

    Susan Anderson, Diagnosed 2014 , Hope Loves Company, USA

  • Jo Knowlton and her dog, Scotland

    Jo Knowlton and her dog, Scotland

  • Ian Gale, MND Australia

    Ian Gale, MND Australia

  • Fabio Carvalho

    Fabio Carvalho

  • Margreth Burger-Saile, Diagnosed 2011,  ALS Schweiz,  Switzerland

    Margreth Burger-Saile, Diagnosed 2011, ALS Schweiz, Switzerland

  • England-Lee-Millard, UK

    England-Lee-Millard, UK

  • Jack Buzby, USA

    Jack Buzby, USA

  • Jon Newsome, USA

    Jon Newsome, USA

  • Animesh Kumar, Diagnosed 2013 , Asha Ek Hope Foundation, India

    Animesh Kumar, Diagnosed 2013 , Asha Ek Hope Foundation, India

  • Susan Keldani, Les Turner ALS Foundation, USA

    Susan Keldani, Les Turner ALS Foundation, USA

  • Brian Lovell, Diagnosed 2011 . MND Australia

    Brian Lovell, Diagnosed 2011 . MND Australia

  • Chun Ju Xiao, China

    Chun Ju Xiao, China

  • Lin Yong Yi, Taiwan MND Association, Diagnosed 2004

    Lin Yong Yi, Taiwan MND Association, Diagnosed 2004

  • March of Faces Photo Submission_OLGA_ELA ARGENTINA

    March of Faces Photo Submission_OLGA_ELA ARGENTINA

  • Steve

    Steve

  • Timmy, ALS Liga

    Timmy, ALS Liga

  • Feng Gin Sun, Diagnosed 2014 , Shaanxi ALS Association, China

    Feng Gin Sun, Diagnosed 2014 , Shaanxi ALS Association, China

  • Ali Var, Turkey

    Ali Var, Turkey

  • Yessenia Hernandez Mendoza, Apoyo Integral Gila A.C., Diagnosed 2018, Mexico

    Yessenia Hernandez Mendoza, Apoyo Integral Gila A.C., Diagnosed 2018, Mexico

  • Chen Yin Xue, Taiwan MND Association, Diagnosed 1995, Taiwan

    Chen Yin Xue, Taiwan MND Association, Diagnosed 1995, Taiwan

  • Dr Shelly Hoover

    Dr Shelly Hoover

  • Claire Garry, USA

    Claire Garry, USA
    20200117_214643

  • Liong Ting Ngu, MND Malaysia, Diagnosed 2014

    Liong Ting Ngu, MND Malaysia, Diagnosed 2014

  • Mary Thomas, Diagnosed 2013 , MND Australia

    Mary Thomas, Diagnosed 2013 , MND Australia

  • Xian-Zhang Niu, Diagnosed 2006 , Shaanxi ALS Association, China

    Xian-Zhang Niu, Diagnosed 2006 , Shaanxi ALS Association, China

  • Karl Hughes, Diagnosed 2010 , IMNDA,  Ireland

    Karl Hughes, Diagnosed 2010 , IMNDA, Ireland

  • 83

    83

  • Maria Santos Garcia Tellez, Diagnosed 2017 , FYADENMAC, Mexico

    Maria Santos Garcia Tellez, Diagnosed 2017 , FYADENMAC, Mexico

  • Wiebke Braach, Deutsche Gesellschaft für Muskelkranke, Germany

    Wiebke Braach, Deutsche Gesellschaft für Muskelkranke, Germany

  • Den Haag, Diagnosed 2016 , The Netherlands

    Den Haag, Diagnosed 2016 , The Netherlands

  • Steve Gallagher, ALS Society of Canada

    Steve Gallagher, ALS Society of Canada
    Picture1

  • Phil Rossall, MND-Association, UK

    Phil Rossall, MND-Association, UK

  • Diana Fernandez, Diagnosed 2009 , Asociación ELA Argentina

    Diana Fernandez, Diagnosed 2009 , Asociación ELA Argentina

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