Riluzole

How it works

It is thought to act by inhibiting glutamate release and stabilising voltage-dependent sodium channels, reducing glutamate-mediated excitotoxicity of motor neurones.

Prescribing in practice

• It can cause hepatotoxicity and dose-dependent rises in transaminases, so liver function must be checked before and regularly during treatment and the drug stopped if enzymes rise markedly.
• Neutropenia has been reported, and any febrile illness should prompt a full blood count.
• It modestly prolongs survival rather than improving symptoms, and expectations should be set accordingly.

Monitoring

Monitor liver transaminases before treatment and periodically thereafter, and check a full blood count if the patient develops a febrile illness.

Counselling the patient

• Report any fever, sore throat or other signs of infection promptly so that blood counts can be checked.
• Report symptoms of liver problems such as jaundice, dark urine or unexplained nausea.
• The medicine aims to slow disease progression rather than relieve existing symptoms.

Evidence & guidelines

Riluzole was shown to prolong survival in amyotrophic lateral sclerosis in landmark randomised controlled trials and is recommended by NICE for this indication.