medicationsnuedextaNuedexta dosage

Nuedexta Dosage, forms & strengths

Jamie Winn, PharmD
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Medically reviewed by  Jamie Winn, PharmD

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Nuedexta is a combination of dextromethorphan hydrobromide and quinidine sulfate that is manufactured by Avanir Pharmaceuticals. It is the first and only FDA-approved medication used in the treatment of pseudobulbar affect (PBA), which involves uncontrolled or inappropriate episodes of laughing or crying. PBA affects almost 2 million people in the United States with neurological conditions including amyotrophic lateral sclerosis, stroke, traumatic brain injury, Parkinson’s disease, Alzheimer’s disease, and multiple sclerosis.

What is Nuedexta’s mechanism of action?

Dextromethorphan is thought to work as a sigma-1 receptor agonist and an NMDA receptor antagonist in your central nervous system (CNS). While these actions affect your mood and behavior, it is not known how it works to reduce PBA symptoms. Quinidine is part of a class of medications called antiarrhythmics. It is used in Nuedexta to increase the level or effect of dextromethorphan.

Nuedexta dosage forms and strengths

  • Dextromethorphan hydrobromide 20mg/quinidine sulfate 10mg capsule

Nuedexta dosage

The starting dose of Nuedexta is 1 capsule by mouth once daily for 7 days. On the eighth day and thereafter, the recommended dose is 1 capsule every 12 hours.

Nuedexta dosage restrictions

  • No dosage adjustment is necessary for patients with mild or moderate renal or hepatic impairment.
  • The pharmacokinetics of this medication have not been studied in patients with severe renal or hepatic impairment but it is likely that dextromethorphan and/or quinidine levels would be increased.

How to take Nuedexta

  • Read the Full Prescribing Information, Drug Information, and Medication Guide that comes with Nuedexta.
  • Take Nuedexta exactly as your doctor prescribes it. Do not change your dose or stop taking this medication without discussing it with them first.
  • The starting dose of Nuedexta is 1 capsule by mouth once daily for 7 days. After 7 days, you will take it twice a day (12 hours apart) with an 8-ounce (240ml) glass of water. You can Nuedexta with or without food.
  • If you miss a dose, don’t double up on your next dose. You should not take more than 2 Nuedexta capsules in a 24-hour period.

Nuedexta dosage FAQs

What are some adverse effects of Nuedexta?

Some common side effects of Nuedexta seen in clinical trials when compared to placebo include:

  • Diarrhea
  • Dizziness which increases your risk of falls
  • Cough
  • Fatigue
  • Vomiting
  • Weakness
  • Urinary tract infection
  • Flu-like symptoms
  • Edema (swelling)
  • Gas
  • Reduced blood pressure

Nuedexta can sometimes cause more serious side effects, including:

  • Serious, life-threatening allergic reactions (hives, swelling of the face or throat, and shortness of breath)
  • Thrombocytopenia (low platelets)
  • Serotonin syndrome
  • QT prolongation and arrhythmias including torsades de pointes
  • Lupus-like syndrome
  • Worsening myasthenia gravis
  • Liver damage including hepatitis and jaundice (yellowing of the skin and eyes)

Contact your healthcare professional for medical advice about any adverse reactions you experience while taking Nuedexta. You can report your side effects to the FDA at 1-800-FDA-1088 or www.fda.gov/medwatch.

What are some drug interactions with Nuedexta?

The concomitant use of Nuedexta with other drugs can affect how they work or increase the frequency and severity of side effects. You should ask your doctor if any of the prescription drugs, over-the-counter medications, vitamins, and herbal supplements you take may interact with Nuedexta, including:

  • Monoamine oxidase inhibitors (MAOIs) such as isocarboxazid and phenelzine
  • Tricyclic antidepressants such as desipramine, clomipramine, and imipramine
  • Selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine and paroxetine
  • Strong and moderate CYP3A4 enzyme inhibitors such as itraconazole
  • Quinine
  • Quinidine
  • Mefloquine
  • Erythromycin
  • Digoxin
  • Thioridazine
  • Pimozide
  • Grapefruit juice

Who should not take Nuedexta?

The use of Nuedexta is contraindicated if you have a known hypersensitivity to dextromethorphan hydrobromide, quinidine sulfate, or any of the inactive ingredients in this product. It should also be avoided in patients:

  • taking quinidine, quinine, or mefloquine.
  • who are currently taking an MAOI or have taken one within the past 14 days.
  • with a history of heart failure, prolonged QT interval, torsades de pointes, or heart failure.
  • with a complete atrioventricular (AV) block without an implanted pacemaker or those at a high risk of complete AV block.
  • taking QT-prolonging medications that are metabolized by CYP2D6 including thioridazine and pimozide.

Is it safe to use Nuedexta while pregnant or breastfeeding?

Animal studies suggest that Nuedexta may cause harm to your unborn baby. Quinidine is found in human breast milk but it is unknown if dextromethorphan is. There is no data on what effects Nuedexta may have on your breastfed infant. You should always discuss the risks and benefits of any medication with your healthcare provider if you are pregnant, plan on becoming pregnant, or are breastfeeding.

When is the best time to take Nuedexta?

Nuedexta should be taken twice a day (every 12 hours) with a full glass of water. It is usually taken in the morning and in the evening or night. Do not take more than 2 capsules of Nuedexta in a 24-hour period.

Is Nuedexta an antidepressant?

No, Nuedexta is not an antidepressant. It is in a drug class called NMDA antagonists.

How long does it take for Nuedexta to start working?

While you may see a reduction in PBA episodes within a week, Nuedexta needs to be taken every day for around 90 days for you to see its full effects.

How should you store Nuedexta?

You should store Nuedexta at room temperature between 59° – 86°F (15° – 30°C).

What is the average price of Nuedexta?

Nuedexta is a very expensive medication. The average cost of #60 Nuedexta 20mg/10mg capsules is approximately $1,700.

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The content on this website is intended for information purposes only. It does not constitute medical advice. The information on this website should not be relied upon and is not a substitute for professional medical advice. You should always speak to your doctor regarding the risks and benefits of any treatment.