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Neuroprotective Agent — ALS/Motor Neurone Disease Pregnancy: Contraindicated — teratogenic in animals; effective contraception mandatory

Riluzole

Brand names: Rilutek, Teglutik (oral suspension)

Adult dose

Dose: 50 mg twice daily
Route: Oral
Frequency: Twice daily (on empty stomach — 1 hour before or 2 hours after meals)
Max: 100 mg/day
Only licensed disease-modifying treatment for ALS (amyotrophic lateral sclerosis / motor neurone disease). Glutamate antagonist — reduces excitotoxicity in motor neurones. Modest effect: extends survival by approximately 2–3 months. Start as soon as diagnosis confirmed. Not a cure — does not reverse disability.

Paediatric dose

Route:
Seek specialist opinion — ALS is primarily an adult condition. Riluzole studied in paediatric-onset SMA and other MND variants under specialist neurology guidance.

Dose adjustments

Renal

Use with caution in renal impairment — no specific adjustment but monitor LFTs and FBC.

Hepatic

Contraindicated in active liver disease or elevated baseline transaminases (>3× ULN).

Clinical pearls

  • Only modest survival benefit (~2–3 months) but this is currently the only licensed AED for ALS — prescribed in all eligible patients. Edaravone (Radicava) approved in some countries but not universally available in UK.
  • LFT monitoring is mandatory — hepatotoxicity can be severe. Stop if ALT >5× ULN.
  • Take on empty stomach: food reduces bioavailability by 20%. Teglutik suspension available for patients with dysphagia (PEG tube administration possible)

Contraindications

  • Active liver disease
  • ALT/AST >3× ULN at baseline
  • Pregnancy (teratogenic)

Side effects

  • Asthenia and fatigue
  • Nausea
  • Elevated LFTs (hepatotoxicity — monitor mandatory)
  • Neutropenia (rare)
  • Dizziness
  • Paraesthesia

Interactions

  • CYP1A2 inhibitors — caffeine, fluvoxamine, ciprofloxacin (increase riluzole levels — hepatotoxicity risk)
  • CYP1A2 inducers — smoking, carbamazepine, rifampicin (reduce riluzole levels)
  • Allopurinol/methyldopa (additive hepatotoxicity)

Monitoring

  • LFTs monthly for 3 months, then quarterly for 1 year, then annually
  • FBC (neutropenia)
  • Clinical progression (ALSFRS-R score)
  • Respiratory function (FVC)

Reference: BNFc; BNF 90; NICE TA20 (Riluzole in ALS); Motor Neurone Disease Association (MNDA) Guidelines; BNFc. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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