From the Guidelines
Nuedexta (dextromethorphan and quinidine) is recommended for patients with emotional lability or pseudobulbar affect causing emotional distress, as a therapeutic trial, according to the American Heart Association/American Stroke Association guidelines 1.
Key Points
- Nuedexta is used to treat pseudobulbar affect (PBA), a condition characterized by uncontrollable laughing or crying episodes.
- The medication combines dextromethorphan and quinidine, which affect brain chemicals that regulate emotion.
- A therapeutic trial of Nuedexta is reasonable for patients with emotional lability or pseudobulbar affect causing emotional distress, as stated in the guidelines 1.
Usage and Monitoring
- Patients should take Nuedexta exactly as prescribed, with or without food, and at regular intervals.
- Common side effects include dizziness, diarrhea, cough, vomiting, weakness, swelling, and urinary tract infections.
- Careful monitoring is required, especially in patients with heart conditions, as quinidine can affect heart rhythm.
- Patients should inform their doctor about all medications they're taking, as Nuedexta may interact with other medications, particularly those metabolized by the CYP2D6 enzyme pathway.
Clinical Considerations
- The guidelines recommend a therapeutic trial of an SSRI or dextromethorphan/quinidine for patients with emotional lability or pseudobulbar affect causing emotional distress 1.
- Periodic reassessment of depression, anxiety, and other psychiatric symptoms may be useful in the care of stroke survivors, and consultation by a qualified psychiatrist or psychologist can be useful for those with mood disorders causing persistent distress or worsening disability 1.
From the Research
Use of Nuedexta
- Nuedexta, a combination of dextromethorphan and quinidine, is used to treat pseudobulbar affect (PBA), a condition characterized by involuntary crying or laughing [ 2, 3, 4, 5 ].
- PBA often occurs 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, 4, 5 ].
- The drug combination is approved for the treatment of PBA and has been shown to reduce the rate of PBA episodes and improve PBA severity in clinical trials [ 2, 4 ].
Mechanism of Action
- Quinidine inhibits the metabolism of dextromethorphan, allowing for high plasma concentrations of dextromethorphan to be reached without using a larger dose of the drug [ 2 ].
- Dextromethorphan has been shown to have a positive effect on the symptoms of PBA when its metabolism is inhibited by quinidine [ 4 ].
Clinical Trials and Case Reports
- Clinical trials have demonstrated the efficacy and safety of dextromethorphan/quinidine in treating PBA in adults with ALS or MS [ 2, 4 ].
- A case report described a patient with a history of traumatic brain injury, partial brain resection, and brainstem stroke who experienced complete resolution of PBA symptoms after being treated with dextromethorphan/quinidine [ 5 ].
- Recent clinical trials also support the use of Nuedexta for improving bulbar function in people with ALS, with or without PBA [ 6 ].