From the Guidelines
Nuedexta is a medication that combines dextromethorphan hydrobromide and quinidine sulfate, and it is FDA-approved for the treatment of pseudobulbar affect.
Key Points
- Pseudobulbar affect is a condition characterized by episodes of involuntary laughing or crying, and it can occur in patients with neurological disorders, including stroke 1.
- The medication is specifically approved for the treatment of pseudobulbar affect, and it works by targeting the brain's neurotransmitter systems to reduce the frequency and severity of episodes 1.
- The assessment and diagnosis of pseudobulbar affect can be done using tools such as the Pathological Laughing and Crying Scale and the Center for Neurological Study-Liability Scale 1.
- In addition to medication, cognitive and emotional therapy, psychotherapy, and support groups can also be effective in managing pseudobulbar affect 1.
- It is essential to acknowledge and educate patients and their families about pseudobulbar affect to defuse potentially uncomfortable situations and promote a better understanding of the condition 1.
The FDA Drug Labels for dextromethorphan (PO) do not address this question.
From the Research
Overview of Nuedexta
- Nuedexta is a combination of dextromethorphan hydrobromide and quinidine sulfate, approved by the Food and Drug Administration (FDA) in 2010 to treat pseudobulbar affect (PBA) 2, 3, 4, 5, 6.
- PBA is a condition of involuntary crying or laughing, often occurring in adults with neurological damage conditions, such as amyotrophic lateral sclerosis (ALS), multiple sclerosis (MS), stroke, traumatic brain injury, Alzheimer's disease, or Parkinson's disease 2, 3, 4, 5, 6.
Mechanism of Action
- The combination of dextromethorphan and quinidine enables high plasma dextromethorphan concentrations to be reached without using a larger dose of the drug, as quinidine inhibits the metabolism of dextromethorphan 2, 6.
- Dextromethorphan is an uncompetitive N-methyl-d-aspartate (NMDA) glutamate receptor antagonist, a sigma-1 receptor agonist, and a serotonin and norepinephrine reuptake inhibitor 6.
Efficacy and Safety
- Studies have shown that Nuedexta reduces the rate of PBA episodes and improves PBA severity in adults with ALS or MS 2, 6.
- The drug combination was generally well tolerated in these studies, with no particular safety or tolerability concerns 2, 6.
- Nuedexta has also been shown to improve bulbar function in people with ALS, with or without PBA 3.
Prescribing Patterns
- Despite FDA approval for pseudobulbar affect based on studies of patients with ALS or MS, Nuedexta appears to be primarily prescribed for patients with dementia and/or Parkinson's disease 5.
- The number of patients prescribed Nuedexta increased significantly between 2011 and 2016, with a corresponding increase in reported spending on the medication 5.