Can Nuedexta (dextromethorphan and quinidine) be used to treat Tardive dyskinesia?

From the Guidelines

Nuedexta (dextromethorphan and quinidine) should not be used to treat Tardive dyskinesia due to the lack of FDA approval and clinical evidence supporting its efficacy for this condition. The medication is specifically approved for treating pseudobulbar affect, a condition characterized by uncontrollable laughing or crying. For tardive dyskinesia, the FDA-approved medications are valbenazine (Ingrezza) and deutetrabenazine (Austedo), which are vesicular monoamine transporter 2 (VMAT2) inhibitors specifically designed to address the abnormal dopamine signaling that causes tardive dyskinesia 1.

Some key points to consider when treating tardive dyskinesia include:

• The American Psychiatric Association recommends treating patients with moderate to severe or disabling tardive dyskinesia associated with antipsychotic therapy with a reversible inhibitor of the vesicular monoamine transporter 2 (VMAT2) 1.
• Valbenazine (Ingrezza) and deutetrabenazine (Austedo) are the FDA-approved VMAT2 inhibitors for treating tardive dyskinesia.
• Dextromethorphan, a component of Nuedexta, may have some activity on NMDA receptors that could theoretically influence movement disorders, but there is insufficient clinical evidence to support its use for tardive dyskinesia.
• The quinidine component in Nuedexta carries risks of cardiac arrhythmias and drug interactions that must be considered when evaluating treatment options.

In terms of treatment guidelines, the American Psychiatric Association recommends a comprehensive and person-centered treatment plan that includes evidence-based nonpharmacological and pharmacological treatments for patients with schizophrenia, which may help reduce the risk of developing tardive dyskinesia 1. Patients experiencing tardive dyskinesia should consult with their healthcare provider about evidence-based treatments like valbenazine or deutetrabenazine rather than pursuing off-label use of Nuedexta.

From the Research

Treatment Options for Tardive Dyskinesia

The treatment of Tardive Dyskinesia (TD) involves various strategies, including the use of specific medications. Some key points to consider are:

• Prevention is the primary approach, which includes careful prescribing of antipsychotic medication and minimizing its duration and dose 2.
• First-line management involves withdrawing the antipsychotic medication if feasible, or switching to a second-generation antipsychotic with lower D2 affinity, such as clozapine or quetiapine 2.
• For patients who cannot discontinue antipsychotics, co-interventions like VMAT2 inhibitors (valbenazine and deutetrabenazine) have shown promise in reducing TD symptoms 2, 3, 4, 5, 6.

Nuedexta and Tardive Dyskinesia

Regarding the use of Nuedexta (dextromethorphan and quinidine) for TD:

• There is no direct evidence from the provided studies to support the use of Nuedexta for treating Tardive Dyskinesia.
• The studies primarily discuss the use of valbenazine and deutetrabenazine, which are VMAT2 inhibitors, as FDA-approved treatments for TD 3, 4, 5, 6.
• Nuedexta is not mentioned in the context of TD treatment in the provided evidence.

Available Treatments

Available treatments for TD include:

• Valbenazine and deutetrabenazine, which have been shown to be effective in reducing TD symptoms and are well-tolerated 5.
• These medications may be considered as a next-line option when traditional strategies are not feasible or ineffective 5, 6.