What is Nuedexta Uses, warnings & interactions
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Get started todayNuedexta (dextromethorphan/quinidine) is a central nervous system (CNS) agent that is manufactured by Avanir Pharmaceuticals and used to treat pseudobulbar affect (PBA). PBA causes involuntary outbursts of crying or laughing in people with certain neurologic conditions such as stroke, Alzheimer’s disease, amyotrophic lateral sclerosis (ALS), multiple sclerosis, Parkinson’s disease, or traumatic brain Injury (TBI).
If your doctor has prescribed Nuedexta to you, you may want to know more about what it is and how it works. Here we’ll explain what Nuedexta is used for, how it works, its side effects, and more.
What is Nuedexta used for?
Nuedexta is a combination of dextromethorphan hydrobromide (NMDA receptor antagonist and sigma-1 agonist) and quinidine sulfate (a CYP2D6 inhibitor) that is used in the treatment of pseudobulbar affect (PBA).
What does Nuedexta do to the brain?
The exact mechanism of action of Nuedexta is not completely known. Dextromethorphan is thought to work by stimulating sigma-1 receptors and blocking NMDA receptors from working. Quinidine helps slow the breakdown of dextromethorphan in the brain.
What are the most commonly prescribed doses of Nuedexta?
- Capsule: Dextromethorphan hydrobromide 20mg and quinidine sulfate 10mg
Before taking Nuedexta
Before taking Nuedexta, tell your healthcare provider about your medical conditions, including:
- Heart problems such as heart failure or heart rhythm disorders
- Kidney or liver problems
- Blood or bone marrow disorders
- Myasthenia gravis
- Are taking mefloquine, quinidine, or quinine, or had a hypersensitivity reaction to one of these medications
- Are taking medications for high blood pressure
- Have taken an MAOI in the past 14 days
- Are pregnant, plan on becoming pregnant, or are breastfeeding
How to take Nuedexta
- Read the Full Prescribing 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.
- Store Nuedexta capsules at room temperature between 59° – 86°F (15° – 30°C).
Nuedexta contraindications
You should not use Nuedexta if you have a known allergy to dextromethorphan hydrobromide, quinidine sulfate, or any inactive ingredients in its formulation. You should also avoid this medication if you:
- are taking quinidine, quinine, or mefloquine, or if you have had a hypersensitivity reaction to one of these medications.
- have taken an MAOI within the last 14 days.
- have a personal or family history of prolonged QT interval, long QT syndrome, torsades de pointes, or heart failure.
- have a complete atrioventricular (AV) block without a pacemaker or are at a high risk of AV block.
- are taking medications that prolong the QT interval and are metabolized by CYP2D6 such as thioridazine and pimozide.
Nuedexta warnings
- Monitor and discontinue Nuedexta if thrombocytopenia (low platelets) or other hypersensitivity reactions occur.
- Nuedexta can cause heart rhythm problems including a prolonged QT interval. Your doctor may perform an ECG if you are taking CYP3A4 inhibitors or other medications that prolong the QT interval.
- Nuedexta can cause dizziness so you should take precautions to reduce your risk of falls.
- This medication may cause serotonin syndrome, especially if taken with serotonin reuptake inhibitors (SSRIs) or tricyclic antidepressants.
- Quinidine has anticholinergic effects and may worsen conditions such as myasthenia gravis.
What drugs should not be taken with Nuedexta?
When Nuedexta is taken with other medications, it may change 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 cause drug interactions with Nuedexta, including:
- MAOIs such as selegiline
- Tricyclic antidepressants such as desipramine
- SSRIs such as paroxetine and fluoxetine
- Quinine
- Quinidine
- Mefloquine
- Digoxin
- Thioridazine
- Pimozide
- Grapefruit juice
What are some possible side effects of Nuedexta?
The most common side effects of Nuedexta seen in clinical trials when compared to placebo include:
- Diarrhea
- Dizziness
- Cough
- Fatigue
- Vomiting
- Weakness
- Urinary tract infection
- Flu-like symptoms
- Swelling
- Gas
Nuedexta can sometimes cause more serious side effects, including:
- Serious, life-threatening allergic reactions (hives, swelling of the face or throat, and trouble breathing)
- Thrombocytopenia (low platelet levels)
- Increased risk of serotonin syndrome
- QT prolongation including torsades de pointes
- Lupus-like syndrome
- Liver damage including hepatitis and jaundice (yellowing of the skin and eyes)
Contact your healthcare professional for medical advice about any possible adverse effects you experience while taking Nuedexta. You can report your adverse effects to the FDA at 1-800-FDA-1088 or www.fda.gov/medwatch.
Nuedexta alternatives
Your doctor can prescribe other medications if Nuedexta is not right for you. Some alternative FDA-approved or off-label treatment options include:
- Elavil (amitriptyline)
- Pamelor (nortriptyline)
- Celexa (citalopram)
- Lexapro (escitalopram)
- Zoloft (sertraline)
Nuedexta FAQs
Can you take Nuedexta while you are pregnant or breastfeeding?
Based on animal studies, Nuedexta may cause fetal harm. Quinidine is excreted in breast milk but it is not known whether dextromethorphan is. It is not known the effects either medication might have on a 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.
Does Nuedexta cause withdrawal symptoms?
Nuedexta does not typically cause withdrawal symptoms after you stop taking this medication. It was not a side effect that was reported during clinical trials.
How long does it take Nuedexta to work?
According to the package insert, patients taking Nuedexta had 44% fewer PBA episodes after 1 week of treatment. You should see the full benefit of this medication in 90 days. As with all medications, your results may vary.
Is Nuedexta an antidepressant?
No, Nuedexta is not an antidepressant. It is in a drug class called NMDA antagonists.
How much does Nuedexta cost?
Currently, there is no generic Nuedexta available on the market. The average cost of #60 Nuedexta 20mg/10mg capsules is approximately $1,700. However, you can save on brand-name drugs like Nuedexta through NiceRx if eligible for assistance.