Can edaravone (edaravone) be given to a patient with dyspnea (shortness of breath)?

Edaravone in Patients with Shortness of Breath

Edaravone can be administered to patients experiencing shortness of breath (dyspnea), but caution is warranted as dyspnea has been reported as a serious treatment-emergent adverse event with this medication. 1, 2

Safety Profile of Edaravone in Relation to Dyspnea

• Dyspnea is among the most commonly reported serious adverse events in patients receiving edaravone treatment for ALS 2
• In post-marketing surveillance data, dyspnea was identified as one of the most frequently reported adverse events in patients treated with edaravone 2
• Recent long-term safety studies of edaravone oral suspension also list dyspnea among the most common treatment-emergent adverse events 3

Clinical Context and Management Considerations

Underlying Cause Assessment

• Before administering edaravone to patients with dyspnea, the underlying cause of shortness of breath should be identified and treated when possible 4
• A stepwise approach to treating dyspnea is recommended, focusing first on treating the etiology when death is not imminent 4

Non-Pharmacological Interventions

• Non-pharmacological interventions should be implemented before or alongside pharmacological treatment for dyspnea 4:
  • Optimal positioning (sitting position, elevation of upper body)
  • Cooling the face, opening windows
  • Using small ventilators to increase ambient air flow
  • Respiratory training techniques 4

Pharmacological Management of Dyspnea

• Opioids remain the first-line pharmacological treatment for dyspnea with sufficient evidence for efficacy 4
• Opioids reduce breathlessness in patients with various conditions including advanced COPD, interstitial lung disease, cancer, and chronic heart failure 4
• For opioid-naïve patients, starting doses for dyspnea are lower than those used for pain palliation 4
• Benzodiazepines can be considered as second-line agents if dyspnea is not adequately controlled with opioids 4

Special Considerations When Using Edaravone

• Monitor patients closely for worsening respiratory symptoms, as respiratory failure has been reported as a serious adverse event with edaravone 1, 2
• Edaravone oral suspension (105 mg) has a bioavailability of 57% compared to intravenous edaravone (60 mg) and should be taken on an empty stomach in the morning 1
• The medication should be administered with water and no food or beverages for 1 hour after administration 1
• Patients with ALS often develop respiratory complications as the disease progresses, so regular assessment of respiratory function is important 1, 3

Conclusion for Clinical Practice

When considering edaravone for a patient with dyspnea:

• Assess and treat the underlying cause of dyspnea first 4
• Implement appropriate non-pharmacological interventions 4
• Consider opioids as first-line pharmacological treatment for dyspnea if needed 4
• If edaravone is indicated for the patient's underlying condition (such as ALS), it can be administered with appropriate monitoring for respiratory symptoms 1, 2, 3
• Be vigilant for worsening dyspnea as this is a reported adverse effect of edaravone therapy 2, 3