Thank you for asking edaravone treatment. It is my honor to help ALS patients with edaravone. Edaravone was approved for the treatment of ALS in June 2015 in Japan, and in May 2017 in USA. If you are considering edaravone treatment at my clinic, please read the followings. If your question is not included, please do not hesitate to ask me.
Edaravone treatment at Yoshino Neurology Clinic
1 Efficacy
  Edaravone cannot cure the disease, but can make the progression of the disease slower approximately 30-40% compared to placebo, if the patient is in early stage (duration of the illness is within 2 years, does not require assistance for daily life, and percent force vital capacity is more than 80). On the other hand, efficacy is not proved for patients with advanced stage.
2 Safety
  Edaravone may cause renal failure if it is used under severe dehydration. Also edaravone sometimes cause elevation of liver enzymes. Patients are recommended to check liver enzymes and kidney parameters once a month. Edaravone may also cause mild skin eruption or headache.
3 Procedure
  In Cycle 1, 60mg (2 ampules) of edaravone dissolved with 200 ml of normal saline will be administered in one hour for 14 days followed by a 2-week drug-free period. In Cycle 2 and thereafter, edaravone will be administered for 10 days within a 14 day period, followed by a 2-week drug-free period. If you feel the disease is progressing worse during drug-free period, 14 days free period can be shorten 7 days or even few days. Drug free period is inserted because of safety consideration. When we started edaravone clinical trial for ALS in 2001, edaravone was said to be toxic to liver and kidney, so we decided to insert 14 days drug-free period in phase 2 trials and following trials. Now we know edaravone is safe drug. Under monitoring liver enzymes and kidney parameters at least once a month, 14 days drug free period can be shorten.
4 How long the treatment should be continued?
  In two phase 3 studies, most patients received 12 cycles, about one year. From my experience, if well responded patient stops edaravone treatment suddenly, the progression will start again. I therefore recommend to the patient if his or her progression of the disease becomes milder, better to continue the treatment. Patient can pick up several months edaravone supply together with the certification letter for Customs. Please check how much supply you can bring into your country. It is different among countries.
5 Cost and payment
  Two ampules with 60 mg of Radicut (brand name of edaravone produced by Tanabe-Mitsubishi pharmaceutical company) cost 8,000 yen. Two ampules of generic edaravone cost 3,000 yen. Edaravone was originally approved for the treatment of acute ischemic stroke in 2001 and the patent of Radicut for stroke was expired 10 years later and generic edaravone is available in Japan. Label for ALS treatment is only given for Radicut at this moment. The efficacy of generic edaravone for ALS should be the same with Radicut. Patient can pay by cash (Japanese yen) or by credit card except AMEX.
6 Accommodation
  My clinic is small and does not have accommodation. Please find some hotels at west side of Chiba or East side of Tokyo. Nearest hotel is either Matsudo Sendan-ya hotel (Tel +81-47-362-0711, English on-line reservation may be available) or Ichikawa grand hotel (Tel +81-47-324-1121).
7 Location and Access
  The address of the clinic is 3-3-16 Kohnodai, Ichikawa-city, Chiba 272-0827, locating in-between Narita and Haneda international airport. Take Keikyu line from Haneda airport, or Keisei line from Narita airport and get off at Yagiri station. It will take about 60 minutes ride on both train. From Yagiri station, it will take about 15 minutes walk to my clinic. Or you can use taxi from either airport to the clinic.
8 Language
  If patient cannot speak English, somebody who can speak English or Japanese must accompany with the patient.
9 If the patient’s health condition is not good to travel to Japan
  On behalf of the patient, family member or friend may come and pick up edaravone to the patient. Medical record is necessary in this situation. Please remind that the efficacy of edaravone is not demonstrated in the advanced stage.
10 Shipping edaravone
  Is not allowed to clinic.
11 If you decide to start edaravone treatment
  Please visit on Monday at around 11 AM or 3 PM with confirmation either by e-mail .
12 How long should the patient stay in Japan?
  I recommend to complete the first cycle of the treatment for 14 days infusion except on Sundays. We can evaluate the safety of edaravone for the patient. If the patient is unable to stay in Japan for long term, please receive the treatment for at least 4 days, from Monday through Thursday. Before starting first cycle of edaravone on Monday, We will check liver enzymes and kidney parameters with blood. Edaravone will be administered from Monday to Thursday, and blood test will be done on Wednesday to make sure edaravone is safe for the patient.
13 In case emergent problem occurs
  Edaravone is safe drug but if some problem occurs, I will refer Kohnodai general hospital locating 10 minutes walk from my clinic.
14 Others
  Edaravone is administered intravenously with drip infusion, so please find doctor or nurse who can help edaravone infusion after going back to your country. If your peripheral vein is very difficult for drip infusion, you may receive port or PICC line.
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