Dextromethorphan Quinidine

Dextromethorphan Quinidine Brand Name– Nuedexta

What is Dextromethorphan Quinidine

Dextromethorphan quinidine is a combination product used for the treatment of pseudobulbar affect (PBA).

PBA occurs secondary to various unrelated neurological conditions, and is characterized by uncontrollable, sudden, and frequent episodes of laughing and/or crying.

Dextromethorphan is an uncompetitive NMDA receptor antagonist and sigma-1 agonist; quinidine is a CYP2D6 inhibitor that increases the systemic bioavailability of dextromethorphan.

Because of the potential for quinidine to cause QT prolongation, certain contraindications apply to the use of dextromethorphan; quinidine.

Controlled studies to support efficacy were performed in patients with amyotrophic lateral sclerosis (ALS) or multiple sclerosis (MS). Dextromethorphan; quinidine has been studied for safety and tolerability in a small number of patients with PBA secondary to other underlying neurological conditions such as stroke, Parkinson’s disease, primary lateral sclerosis, Alzheimer’s disease, and traumatic brain injury.

Dextromethorphan quinidine has not been shown to be safe and effective in other types of emotional lability that can occur in patients with neurological diseases.

In October 2010, dextromethorphan; quinidine (Nuedexta) was approved by the FDA for the treatment of pseudobulbar affect in adults.

Indications

• pseudobulbar affect

For the treatment of pseudobulbar affect (PBA)\

Side Effects

1. abdominal pain
2. asthenia
3. ataxia
4. blurred vision
5. confusion
6. cough
7. delirium
8. depression
9. diarrhea
10. diplopia
11. dizziness
12. drowsiness
13. flatulence
14. headache
15. hearing loss
16. hepatitis
17. infection
18. influenza
19. keratopathy
20. lupus-like symptoms
21. muscle cramps
22. mydriasis
23. nausea
24. night blindness
25. optic neuritis
26. peripheral edema
27. photophobia
28. photosensitivity
29. psychosis
30. QT prolongation
31. restlessness
32. scotomata
33. seizures
34. skin discoloration
35. thrombocytopenia
36. tinnitus
37. vertigo
38. visual impairment
39. vomiting

Monitoring Parameters

• laboratory monitoring not necessary

Contraindications

• alcoholism
• AV block
• bone marrow suppression
• bradycardia
• breast-feeding
• cardiac arrhythmias
• cardiac disease
• children
• coronary artery disease
• dementia
• diabetes mellitus
• electrolyte imbalance
• females
• geriatric
• heart failure
• hepatic disease
• hepatitis
• hypertension
• hypocalcemia
• hypokalemia
• hypomagnesemia
• infants
• long QT syndrome
• malnutrition
• MAOI therapy
• myasthenia gravis
• myocardial infarction
• neonates
• pregnancy
• QT prolongation
• renal disease
• renal failure
• renal impairment
• stroke
• substance abuse
• thrombocytopenia
• thyroid disease
• torsade de pointes
• ventricular dysfunction

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