There is no cure for ALS, but several treatments can slow the disease, manage symptoms, and extend survival. Two FDA-approved medications target disease progression directly, and a range of supportive therapies address breathing, nutrition, muscle stiffness, and quality of life. Treatment for ALS is not a single intervention but a combination of approaches tailored as the disease progresses.
Medications That Slow Progression
Riluzole was the first drug approved for ALS and remains a standard part of treatment. It works by reducing nerve cell damage, though the exact mechanism is still debated. Scientists believe it may protect motor neurons by lowering levels of a chemical messenger called glutamate, which in excess can be toxic to nerve cells. The survival benefit is modest: riluzole extends life by roughly two to three months on average, translating to about a 9% increase in the chance of surviving one year. It’s taken as a daily oral tablet and is generally started soon after diagnosis.
Edaravone is the second approved option. It acts as an antioxidant, scavenging harmful molecules that damage nerve cells. Originally available only as an intravenous infusion given in cycles over several days at a time, an oral liquid form is now approved, making it far more practical. The oral version follows the same dosing schedule: daily doses for two weeks, then two weeks off, repeating in cycles. It needs to be taken on an empty stomach after an overnight fast, with no food or drink for an hour afterward. For people who have a feeding tube, the medication can be given through it without adjusting the dose.
A Treatment That Didn’t Hold Up
If you’ve heard of Relyvrio, it’s worth knowing that its FDA approval was formally withdrawn in August 2025. A large Phase 3 clinical trial called PHOENIX failed to show that it met any of its primary or secondary goals for slowing ALS progression. The manufacturer voluntarily requested withdrawal after those results came in. If you see older articles recommending it, that information is outdated.
Gene-Targeted Therapy for SOD1 Mutations
About 2% of all ALS cases are caused by a mutation in a gene called SOD1. For this small group, a targeted treatment called tofersen is available. It’s an antisense therapy, meaning it’s designed to reduce production of the faulty SOD1 protein at the genetic level. It’s delivered by injection into the spinal fluid.
Long-term data from clinical trials show tofersen reduced a key marker of nerve damage in the blood (neurofilament light chain) by 64% to 67% depending on when patients started treatment. For people whose disease was progressing faster, the reductions were even larger, reaching 76% to 79%. This treatment only works for people with a confirmed SOD1 mutation, so genetic testing is a necessary first step. Several other gene therapies targeting SOD1 are in early clinical trials but are not yet available outside of research settings.
Breathing Support
As ALS weakens the muscles used for breathing, respiratory support becomes one of the most important treatments. Non-invasive ventilation, a mask-based system that assists breathing (similar to a CPAP machine), is the primary tool. A randomized controlled trial published in The Lancet Neurology found that it extended survival by a median of 205 days, nearly seven months, while also improving quality of life for most of that period.
Doctors typically monitor lung function using a test called forced vital capacity, which measures how much air you can exhale forcefully. As that number declines, your care team will introduce ventilation support and adjust it over time. Most people start using it at night, when breathing naturally weakens during sleep, and gradually increase use during the day as needed.
Nutritional Support and Feeding Tubes
Swallowing difficulties are common as ALS progresses, leading to weight loss, dehydration, and a higher risk of choking. When someone has lost 5% or more of their usual body weight, or their forced vital capacity drops to around 50% of what’s predicted for their age and size, a feeding tube is typically discussed. The standard approach is a PEG tube, a small tube placed directly into the stomach through the abdominal wall.
Timing matters. Placing the tube while lung function is still adequate makes the procedure safer and gives people time to get comfortable with it before they rely on it fully. Many people continue eating some foods by mouth for enjoyment while using the tube to ensure they get enough calories and hydration. Maintaining weight is strongly linked to better outcomes and slower progression in ALS.
Managing Day-to-Day Symptoms
ALS produces a range of symptoms beyond the core muscle weakness, and targeted treatments exist for many of them.
Muscle stiffness and spasticity are treated with muscle relaxants. Baclofen is the most commonly used first-line option, with doses adjusted upward as needed. For more severe stiffness, tizanidine is an alternative. Both can cause drowsiness or weakness, so doses are started low and increased gradually.
Pseudobulbar affect is a condition where people experience sudden, uncontrollable laughing or crying that doesn’t match how they actually feel. It occurs in a significant number of ALS patients and can be socially distressing. A combination medication containing dextromethorphan and quinidine is the only FDA-approved treatment specifically for this symptom, taken twice daily.
Excessive drooling happens because weakened swallowing muscles allow saliva to pool in the mouth, not because the body produces more saliva. Treatments range from medications that reduce saliva production to injections that target the salivary glands directly.
Physical and occupational therapy help maintain mobility and independence for as long as possible. Speech therapy, along with communication devices, becomes important as speaking grows more difficult. These aren’t cures, but they have a real impact on daily life.
Multidisciplinary Care Makes a Difference
One of the clearest findings in ALS research is that people who receive care from a coordinated team of specialists, including neurologists, respiratory therapists, nutritionists, physical therapists, speech therapists, and social workers, live longer and report better quality of life than those who see providers individually. ALS clinics that bring these specialists together in one visit reduce the burden of appointments and catch problems earlier, from breathing changes to nutritional decline to equipment needs.
The treatment landscape for ALS is real but honest: no single therapy reverses the disease, and the benefits of each intervention vary from person to person. What makes the biggest difference is combining disease-slowing medications with aggressive symptom management and supportive care, started early and adjusted continuously as needs change.