Medication Options to Treat Amyotrophic Lateral Sclerosis (ALS)

Overview

Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disorder that affects the nerves responsible for muscle movement. There are currently several medications used to treat ALS. Let's take a look at each medication type, their effects in helping to treat ALS, and their potential precautions or side effects:

Glutamate Inhibitors

• Effect: These medications include riluzole, the first medication approved by the FDA for ALS treatment. They work by reducing the release of glutamate, a neurotransmitter that can be toxic to nerve cells. By doing so, it may slow down disease progression and extend survival by about 3 months.
• Precautions/Side Effects: Common side effects can include nausea, vomiting, stomach pain, dizziness, and weakness. It's important to discuss any liver problems or allergies with your doctor before starting this medication.

Neurologics

• Tofersen:
  • Effect: Tofersen is an antisense oligonucleotide that blocks production of mSOD1, which is the second most common and best understood genetic cause of ALS, in patients with SOD1 ALS. It has been approved by the FDA for patients with SOD1 ALS.
  • Precautions/Side effects: Common side effects can include pain, fatigue, arthralgia, increase in cerebrospinal fluid (CSF) white blood cells and myalgia
• Edavarone:
  • Effect: These medications help reduce oxidative stress in the body and slow down functional decline in some patients. Oxidative stress is thought to contribute to nerve cell damage in ALS.
  • Precautions/Side Effects: Common side effects can include contusion, gait disturbance, headache, dermatitis and eczema

Skeletal Muscle Relaxants

• Baclofen:
  • Effect: This medication helps to relieve muscle spasms.
  • Precautions/Side Effects: Common side effects include drowsiness, dizziness, weakness, nausea, confusion and somnolence (sleepiness). It's important to discuss any liver problems or allergies with your doctor before starting this medication.

Alpha2 Adrenergic Agonists

• Tizanidine:
  • Effect: This medication works by decreasing the activity in certain nerves in the brain and body.
  • Precautions/Side Effects: Common side effects include dry mouth, somnolence, dizziness and asthenia (generally feeling weak and fatigued).

NMDA Antagonists

• Dextromethorphan and quinidine:
  • Effect: This medication decreases emotional lability (rapid, exaggerated changes in mood) of pseudobulbar affect (sudden laughing or crying without meaning to)
  • Precautions/Side Effects: Common side effects include diarrhea, dizziness, cough, vomiting, and asthenia.

It's important to note that while these medications have shown some benefits in treating ALS, they may not work for everyone and their effects may vary from person to person. Always consult with your doctor before starting any new medication or treatment for ALS as they can provide personalized advice based on your specific situation.