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dextromethorphan/quinidine (Nuedexta)
Indications:
- treatment of pseudobulbar affect associated with amyotrophic lateral sclerosis, multiple sclerosis & other disorders
- agitation in patients with Alzheimer's disease
Dosage:
- start one tablet PO QD
- after 7 days, increase to one tablet PO BID
Adverse effects:
- most common
- diarrhea
- vomiting
- flatulence
- dyspepsia
- cough
- xeropthalmia, xerostomia
- muscle weakness, muscle spasms
- peripheral edema
- urinary frequency, dysuria
- cloudy urine, malodorous urine
- potentially serious effects
- fever
- unusual bleeding or bruising
- myalgia, arthralgia
- rash
- angioedema
- lymphadenopathy
- hoarseness
- dyspnea
- lightheadedness
- syncope
- tachycardia
Drug interactions:
- mefloquine (Lariam), pimozide (Orap), quinine (Qualaquin) thioridazine
- also see dextromethorphan & quinidine
Mechanism of action:
- dextromethorphan* is the active component, mechanism unknown
- quinidine increases half life of dextromethorphan
* dextromethorphan is an antitussive agent & a weak NMDA receptor antagonist (probably less potent than memantine)
Note:
- CNN reports drug over prescribed in nursing home
Interactions
drug interactions
General
pharmacologic combination
References
- PubMed Health
Dextromethorphan and Quinidine
http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0016263/
- Cummings JL. Lyketsos CG, Peskind ER et al
Effect of Dextromethorphan-Quinidine on Agitation in Patients
With Alzheimer Disease Dementia. A Randomized Clinical Trial.
JAMA. 2015;314(12):1242-1254
PMID: 26393847
http://jama.jamanetwork.com/article.aspx?articleid=2442936
- Ballard C, Sharp S, BSc1; Anne Corbett A
Dextromethorphan and Quinidine for Treating Agitation in Patients
With Alzheimer Disease Dementia
JAMA. 2015;314(12):1233-1235.
PMID: 26393843
http://jama.jamanetwork.com/article.aspx?articleid=2442913
- Ellis B, Hicken M, Hernandez S
The little red pill being pushed on the elderly.
CNN investigation exposes inappropriate use of drug in nursing
homes.
http://www.cnn.com/2017/10/12/health/nuedexta-nursing-homes-invs/index.html
- HIGHLIGHTS OF PRESCRIBING INFORMATION
http://www.nuedexta.com/NUEDEXTA_Full_Prescribing_Information-1.pdf
Components
dextromethorphan (Benylin DM)
quinidine [gluconate (Quinaglute, Quinalan) & sulfate (Quinidex, Quinora)]