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Amyotrophic lateral sclerosis Riluzole Hypertension . Blood pressure . Adverse effects
Abstract
Objective: To determine whether riluzole is associated with blood pressure elevations in patients with amyotrophic lateral sclerosis (ALS). Background: Though previously reported, hypertension is not considered a frequent adverse effect of riluzole. Methods: We reviewed data from 35 consecutive ALS patients on riluzole, and 88 randomly selected controls without and 20 patients with ALS who were not on riluzole. Results: A significantly greater number of ALS patients on riluzole had blood pressure elevations (28 of 35 patients) compared to controls (26 of 88, p < 0.001; 8 of 20, p = 0.007). Median systolic and diastolic blood pressures were both significantly higher in riluzole-treated (140/86 mm Hg) than in control patients without ALS (120/70 mm Hg, p < 0.001 ). Systolic, but not diastolic, blood pressures were significantly higher in riluzole-treated patients than in controls with ALS (126 mm Hg, p = 0.002). Conclusions: Riluzole treatment may be associated with mild blood pressure elevations. Future prospective trials of riluzole should closely assess hypertension.
Copyright 2000 S. Karger AG. Basel
Introduction
Riluzole is the only drug shown to increase survival of patients with amyotrophic lateral sclerosis (ALS) in double-blind, placebo-controlled trials [1, 2]. Riluzole's effect on survival is quite modest. However, the lack of serious adverse effects reported to date supports its use. The adverse effect which results in the greatest number of treatment withdrawals is a dose-dependent increase in liver transaminases [2]. This requires monitoring of liver function tests, but reverses with cessation of riluzole.
Hypertension is not considered a frequent adverse effect of riluzole, and no dose-effect has been shown in humans. Animal studies show no significant blood pressure effects with riluzole doses up to 30 mg/kg orally [3]. However, mild to moderate blood pressure elevations occurred in 4 of 77 ALS patients treated with riluzole compared to 0 of 78 patients treated with placebo [1]. In addition, riluzole stabilizes inactivated sodium channels, and epithelial sodium channels likely play a role in the regulation of blood pressure [3-6].
We observed frequent hypertension in patients with ALS after riluzole became available. We then studied whether riluzole was associated with blood pressure elevations by comparing blood pressure data in...