Table 1.
Suggested drugs: their dosages, pharmacodynamics, and pharmacokinetics.
| Drug | Suggested Dose | Serious Adverse Effects (SAE) | Drug-Drug Interactions | Effects of Comorbidities | Effects of Age | Effects of Pregnancy |
|---|---|---|---|---|---|---|
| clemastine | 5.36 mg bid (a) | None | ||||
| erythropoietin | 10,000 IU IM once/month | SAE only if high dosage. | ||||
| fingolimod | 0.5 mg/day | (b) | ||||
| fluoxetine | 10 mg/day | (c), (d). | No effect | |||
| lithium | 75 mg/day | (e), (f), (g), (h), (i), (j). | Avoid if GFR < 60 mL/min. | Avoid in pregnancy | ||
| memantine | 5 mg qd ×7d, then bid (j). | (k). | Avoid if GFR < 60 mL/min. | |||
| minocycline | 100 mg/day | (l), (m), (n), (o). | ||||
| piracetam | 1.2 G/day | No SAE | None | |||
| pioglitazone | 15 mg/day | No SAE | ||||
| riluzole | 100 mg/day | (p). |
See text for descriptions of therapeutic effects. Suggested two-drug combinations are pioglitazone plus fluoxetine or pioglitazone plus lithium. Suggested three-drug combinations would add one drug from clemastine, fingolimod, or memantine. (a) this high dose for a study was approved by FDA. (b) fingolimod may cause transient 20 heart block. (c), fluoxetine + lithium may cause serotonergic syndrome. (d), fluoxetine may increase blood levels of antipsychotic drugs. Lithium may cause (e) hypercalcemia, (f) hypothyroidism, (g) rarely hyperthyroidism, (h) GFR may fall; do not use if GFR < 60 mL/min, (i) ~20% patients In clinical trials, quit Rx due to adverse events, (j) NB suggested very low dosage is unlikely to cause problems. (k) Use a lower dose of memantine in (j) elderly patients. (k) do not use if GFR < 60 mL/min. (l) vestibular symptoms are the commonest side effect but infrequent. (m) systemic lupus erythematosus as SAE is serious but rare; ANA testing before commencing Rx is mandatory, (n) other hypersensitivity syndromes may also occur, (o) cutaneous and dental hyperpigmentation occurs with prolonged Rx, (p) Liver enzymes abnormal in ~10% Rx’ed with riluzole.