Medications to Avoid With Amyotrophic Lateral Sclerosis (ALS)

Overview

When it comes to medications for amyotrophic lateral sclerosis (ALS), certain medications should be avoided because they may cause serious side effects or worsen symptoms. It’s important to work closely with your healthcare professional to determine which medications are safe and which ones to avoid.

Here are some types of medications that may need to be avoided in ALS:

• Medications that affect breathing: ALS can weaken the muscles that help you breathe. Certain medications that slow down breathing or cause sedation may make this problem worse. These include:
  • Opioids (like morphine or oxycodone)
  • Benzodiazepines (like lorazepam or diazepam)
  • Barbiturates (used for seizures or sedation)
• If these medications are necessary, they should be used in very small amounts and under close supervision.
• Medications that cause muscle weakness: ALS affects muscle strength, so medications that further weaken muscles should be avoided unless absolutely necessary. Examples include:
  • Neuromuscluar blocking agents, like succinylcholine, which may be used dury surgery or in emergencies. This drug can cause dangerously high potassium levels in people with ALS.
• Immune-modulating drugs: Certain medications used to treat other neurological conditions, like multiple sclerosis, are not helpful for ALS and may increase the risk of infections or other problems. These include:
  • Fingolimod
  • Natalizumab
  • Alemtuzumab

These drugs are not proven to work for ALS and should not be used unless prescribed by a specialist.

• Antipsychotic medications: Some medications used to treat mood of behavior changes can cause side effects that make ALS symptoms worse. For exmaple:
  • Haloperidol may cause stiffness or muscle problems.
  • Clozapine or olanzapine can make swallowing or breathing more difficult.

If you need these medications, your healthcare provider can recommend safer alternatives.

• Certain antibiotics: Some antibiotics can weaken muscles or interfere with nerve signals, which may worsen ALS symptoms. Examples include:
  • Fluoroquinolones (like ciprofloxacin or levofloxacin)
  • Aminoglycosides (like gentamicin)

Talk to your healthcare provider if you need antibiotics, so they can choose a safer option.

• Medications that affect swallowing or saliva production: Many people with ALS have trouble swallowing. Certain drugs can make this worse, such as:
  • Anticholinergics (like atropine) when used in high doses. These are often prescribed to reduce saliva but should be carefully managed.
  • Muscle relaxants (like baclofen) if they cause too much muscle weakness.

It's crucial to understand that while certain medications may offer benefits for specific conditions, their effects can vary among individuals. Therefore, it is essential to discuss the potential benefits and risks of each medication with your healthcare professional before making any decisions.

Some medications, such as methylcobalamin, masitinib, and CNM-Au8, have shown promise in clinical trials for ALS treatment. These drugs have demonstrated potential therapeutic effects, but further research is needed, and they are not yet widely recommended. Always consult your healthcare professional to learn about current treatments and ongoing trials.

Remember, always consult with a doctor before starting or stopping any medication, as they can provide personalized guidance based on an individual's specific circumstances and medical history.

Medication dosing may be affected by many factors. Check with your health care professional about dosing for your individual situation. Other side effects can occur. Check with your health care professional or read the information provided with your medication for additional side effect information.