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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

  • Philip Brindle,  MND Association,  Diagnosed 2015,  England

    Philip Brindle, MND Association, Diagnosed 2015, England

  • Bob Simonds and Drew O'Neill , Les Turner ALS Foundation, USA

    Bob Simonds and Drew O’Neill , Les Turner ALS Foundation, USA

  • Bob Simonds and Drew O'Neil, USA

    Bob Simonds and Drew O’Neil, USA

  • Alejandro Aquino, Diagnosed 2011 , Asociación ELA Argentina

    Alejandro Aquino, Diagnosed 2011 , Asociación ELA Argentina

  • Claudia Gotti, Brazil

    Claudia Gotti, Brazil

  • Wilfried Leusing, Diagnosed 2010 , DGM, Germany

    Wilfried Leusing, Diagnosed 2010 , DGM, Germany

  • Willi Klein

    Willi Klein

  • Dr Shelly Hoover

    Dr Shelly Hoover

  • Joy Blakeley, Diagnosed 2017 , MND Australia

    Joy Blakeley, Diagnosed 2017 , MND Australia

  • Armando González Gómez, ACELA, Colombia

    Armando González Gómez, ACELA, Colombia

  • Sally Pauls, Diagnosed 2006 , Les Turner ALS Foundation

    Sally Pauls, Diagnosed 2006 , Les Turner ALS Foundation

  • John Dinon, MND Australia

    John Dinon, MND Australia

  • Leon Ryba, Argentina

    Leon Ryba, Argentina

  • Den Haag, Diagnosed 2016 , The Netherlands

    Den Haag, Diagnosed 2016 , The Netherlands

  • Horacio Fritzer, Argentina

    Horacio Fritzer, Argentina

  • Emilienne Verhaegen, ALS Liga Belgium, Diagnosed 2014

    Emilienne Verhaegen, ALS Liga Belgium, Diagnosed 2014

  • Mauril Bélanger, Diagnosed 2015 , ALS Canada

    Mauril Bélanger, Diagnosed 2015 , ALS Canada

  • Chen Chun-Chin

    Chen Chun-Chin

  • Dawn Morton, Diagnosed 2014 , MND Scotland, UK

    Dawn Morton, Diagnosed 2014 , MND Scotland, UK

  • Zelina Brito, Diagnosed 2018, Brazil

    Zelina Brito, Diagnosed 2018, Brazil

  • Danny Reviers, Diagnosed 1979 , ALS Liga België, Belgium

    Danny Reviers, Diagnosed 1979 , ALS Liga België, Belgium

  • Sébastien Batiot, Diagnosed 2012 , ARSLA, France

    Sébastien Batiot, Diagnosed 2012 , ARSLA, France

  • Tammy Moore and Eddy Lefrancois

    Tammy Moore and Eddy Lefrancois

  • Eric Von Schaumburg, USA

    Eric Von Schaumburg, USA

  • Joanne Pratt, Diagnosed 2011 , MND Australia

    Joanne Pratt, Diagnosed 2011 , MND Australia

  • Conny van der Meijden, Diagnosed 2001,  ALS Netherlands

    Conny van der Meijden, Diagnosed 2001, ALS Netherlands

  • England-Lee-Millard, UK

    England-Lee-Millard, UK

  • Chris McCauley, Diagnosed 2015 , ALS Canada

    Chris McCauley, Diagnosed 2015 , ALS Canada

  • Frank "Papa" Taylor

    Frank “Papa” Taylor

  • Oliver Juenke, Germany

    Oliver Juenke, Germany

  • Hanne Stenmose, Muskelsvindfonden, Denmark

    Hanne Stenmose, Muskelsvindfonden, Denmark

  • Marco Antonio Alvarez Mercado, Mexico

    Marco Antonio Alvarez Mercado, Mexico

  • Duncan Bayly , MND Australia

    Duncan Bayly , MND Australia

  • Marcelo Farinelli, Diagnosed 2006, ABrELA, Brazil

    Marcelo Farinelli, Diagnosed 2006, ABrELA, Brazil

  • 83

    83

  • Shay Rishoni

    Shay Rishoni

  • Dick Dayton, USA

    Dick Dayton, USA

  • Robbie Caliste, UK

    Robbie Caliste, UK

  • 393647_2252248542053_984912751_n

    393647_2252248542053_984912751_n

  • Joyce Rusinak, Forbes Norris ALS Center, USA

    Joyce Rusinak, Forbes Norris ALS Center, USA

  • Catherine Pearce, Australia

    Catherine Pearce, Australia

  • Amparo Muriel Engativa, Colombia

    Amparo Muriel Engativa, Colombia

  • David Bishop

    David Bishop

  • Peng Yi-Wen

    Peng Yi-Wen

  • Wiebke Braach, Deutsche Gesellschaft für Muskelkranke, Germany

    Wiebke Braach, Deutsche Gesellschaft für Muskelkranke, Germany

  • Michel Perrozzo, ARSLA, Diagnosed 2015, France

    Michel Perrozzo, ARSLA, Diagnosed 2015, France

  • Chih Ching Darren Wong, MND Malaysia

    Chih Ching Darren Wong, MND Malaysia

  • Christian Bär, Germany

    Christian Bär, Germany

  • Ian and Teresa Roberts

    Ian and Teresa Roberts

  • Richard Clark, MND New Zealand,  Diagnosed 2011

    Richard Clark, MND New Zealand, Diagnosed 2011

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