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# Neuroprotective agents for ALS

Riluzole and edaravone, medicines that modestly slow amyotrophic lateral sclerosis. They do not cure it or restore lost strength.

Updated 2026-11-01

## What they are

Amyotrophic lateral sclerosis (ALS) destroys upper and lower motor neurons. Riluzole, which reduces glutamate signalling, prolongs survival by a few months; edaravone, a free-radical scavenger given intravenously in cycles, slowed functional decline in early ALS in one trial. Tofersen, an antisense drug for SOD1 ALS, belongs to the same field.

## Mechanism of action

Excess glutamate and oxidative stress are thought to contribute to motor neuron death. Riluzole inhibits glutamate release, blocks voltage-gated sodium channels and some glutamate receptors; edaravone mops up free radicals. The exact mechanism of benefit in ALS is unknown for both.

Target: Glutamate signalling and sodium channels (riluzole); free radicals (edaravone)

## Key points

- Riluzole: liver injury (aminotransferases are checked), neutropenia and, rarely, interstitial lung disease.
- Riluzole is metabolized by CYP1A2: inhibitors such as ciprofloxacin raise its levels and inducers lower them.
- Edaravone infusions contain sodium bisulfite, which can cause allergic reactions, especially in people with asthma.

## Drugs in this class

- [**Riluzole** The first drug shown to prolong life in ALS, by a few months. It reduces glutamate signalling; liver tests are checked. Voltage-gated sodium channels and glutamate signalling](https://durgical.com/en/pharmacology/riluzole/)
- [**Edaravone** A free-radical scavenger given in intravenous cycles (or by mouth) that modestly slowed functional decline in early… Free radicals (oxidative stress)](https://durgical.com/en/pharmacology/edaravone/)

## Others in the class

- Tofersén

## Test yourself

Think of the answer, then tap the question to see it.

## Which ALS drug inhibits glutamate release and blocks sodium channels?

Riluzole.

## Which laboratory test is followed during riluzole treatment?

Serum aminotransferases (liver injury); blood counts are also watched for neutropenia.

## Which excipient of edaravone infusions can cause allergic reactions?

Sodium bisulfite (a sulfite).

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Educational content on how drugs work; not a prescribing guide and no substitute for a health professional's advice. No doses are given.

Sources: Goodman & Gilman's The Pharmacological Basis of Therapeutics, 14th ed., ch. 21 (McGraw Hill, 2023); [DailyMed - RILUZOLE tablet](https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=dd432c13-389e-46b3-8891-0cf1a58800ff) (DailyMed (U.S. National Library of Medicine), 2026); [DailyMed - EDARAVONE injection, solution](https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=19862ae9-d6e1-70e6-e063-6394a90ae749) (DailyMed (U.S. National Library of Medicine), 2025); [ATCDDD - ATC/DDD Index](https://atcddd.fhi.no/atc_ddd_index/?code=N07XX) (WHO Collaborating Centre for Drug Statistics Methodology, 2026).

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Representative model, for educational purposes only.

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License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/pharmacology/classes/neuroprotective-agents-for-als/