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ALS Worldwide
February 02, 2015

Mexiletine Hydrochloride May Relieve Cramping

Mexiletine, the generic form of Mexitil, was originally developed for heart arrhythmia treatment, but is also prescribed to treat nerve damage because of its ability to balance electrolytes in the blood. Irregular electrolyte levels are likely to trigger a cascade of molecular events that eventually lead to cell death and, therefore, neuronal death—which can cause weakness, muscle twitching, numbness and fatigue. It may also be of help in relieving limb symptoms in ALS. A phase II, 60 patient NEALS-sponsored multicenter randomized controlled trial of Mexiletine in the treatment of ALS was recently completed.  Patients were randomized to placebo, 300 mg, or 900 mg of Mexiletine and followed over 12 weeks. The primary outcome measures were safety and tolerability.

Dr. Michael Weiss of the University of Washington School of Medicine, and Principal Investigator on the Mexiletine trial, states, “The trial clearly shows that Mexiletine is safe to use in ALS patients and reasonably well tolerated, which is what we had hoped when we initiated the study. The dramatic effects on muscle cramps are much more than what we expected and suggest that Mexiletine could become a treatment of choice for this often substantial and debilitating complication of ALS. Determining whether Mexiletine can definitively slow progression of the disease will likely require a larger and longer study." This medication may be of particular help to ALS patients in regards to limb symptoms, which include weakness, muscle twitching, pain, numbness and fatigue.

Pain caused by nerve injury is notoriously difficult to treat and is often referred to as a syndrome. The treatment of these pain syndromes with salt channel regulation is relatively new and regarded with high potential. Mexiletine has been successfully used for pain reduction and has had a positive impact on diabetic neuropathy (nerve damage caused by diabetes). 

While Mexiletine may alleviate ALS symptoms, it does not treat the systemic disease and is not a cure. Patients taking this medication should avoid caffeinated beverages because mexiletine can decrease the speed at which the body breaks down caffeine and therefore increase caffeine’s effects and side effects. Vegetarian or largely-vegetarian diets should also be discussed, as they may affect your usage of this drug.

Patients should discuss this and any other recommendations or suggestions with their physician. Mexiletine requires a physicians prescription.

If you or your physician have any questions or would like to discuss our viewpoints regarding this medication, please email us at [email protected]