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Dextromethorphan/Quinidine: A Review of Its Use in Adults with Pseudobulbar Affect

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Abstract

Fixed-dose dextromethorphan/quinidine capsules (Nuedexta®) utilize quinidine to inhibit the metabolism of dextromethorphan, enabling high plasma dextromethorphan concentrations to be reached without using a larger dose of the drug. The drug combination is the first treatment to be approved for pseudobulbar affect (PBA), a condition of contextually inappropriate/exaggerated emotional expression that 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. Dextromethorphan/quinidine at the recommended dosages of 20/10 or 30/10 mg twice daily reduced the rate of PBA episodes and improved PBA severity in a 12-week, double-blind, placebo-controlled trial in adults with ALS or MS (STAR), with further improvements in the severity of the condition observed in a 12-week open-label extension phase. Dextromethorphan/quinidine 20/10 mg twice daily also improved PBA secondary to dementia in a cohort of a 12-week noncomparative trial (PRISM II). The drug combination was generally well tolerated in these studies, with no particular safety or tolerability concerns. Although longer-term efficacy and tolerability data for dextromethorphan/quinidine 20/10 or 30/10 mg twice daily would be beneficial, current evidence indicates that it is a useful option in the treatment of adults with PBA.

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Disclosure

The preparation of this review was not supported by any external funding. During the peer review process, the manufacturer of the agent under review was offered an opportunity to comment on this article. Changes resulting from comments received were made by the authors on the basis of scientific and editorial merit. Lily Yang and Emma Deeks are salaried employees of Springer.

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  1. Springer, Private Bag 65901, Mairangi Bay 0754, Auckland, New Zealand

    Lily P. H. Yang & Emma D. Deeks

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  1. Lily P. H. Yang
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  2. Emma D. Deeks
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Correspondence to Emma D. Deeks.

Additional information

The manuscript was reviewed by: J. M. Silver, Department of Psychiatry, New York University School of Medicine; New York, NY, USA; L. Zawertailo, Centre for Addiction and Mental Health, Department of Pharmacology, University of Toronto, Toronto, Canada.

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Yang, L.P.H., Deeks, E.D. Dextromethorphan/Quinidine: A Review of Its Use in Adults with Pseudobulbar Affect. Drugs 75, 83–90 (2015). https://doi.org/10.1007/s40265-014-0328-z

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