Treatment of pseudobulbar affect in ALS with dextromethorphan/quinidine

@article{Brooks2004TreatmentOP,
  title={Treatment of pseudobulbar affect in ALS with dextromethorphan/quinidine},
  author={Benjamin Rix Brooks and Ronald A. Thisted and Stanley H Appel and Walter G Bradley and Richard Olney and James E. Berg and Laura E. Pope and R A Smith},
  journal={Neurology},
  year={2004},
  volume={63},
  pages={1364 - 1370}
}
Background: Patients with ALS commonly exhibit pseudobulbar affect. Methods: The authors conducted a multicenter, randomized, double-blind, controlled, parallel, three-arm study to test a defined combination of dextromethorphan hydrobromide (DM) and quinidine sulfate (Q) (AVP-923) for the treatment of pseudobulbar affect in ALS. Q inhibits the rapid first-pass metabolism of DM. The effects of AVP-923 (30 mg of DM plus 30 mg of Q) given twice daily for 28 days were compared with those of its… 
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Dextromethorphan/quinidine for the treatment of pseudobulbar affect.
  • E. Patatanian, J. Casselman
  • Medicine
    The Consultant pharmacist : the journal of the American Society of Consultant Pharmacists
  • 2014
TLDR
Based on the data available, DM/Q may be a viable, short-term treatment alternative for PBA, and long-term safety and efficacy data are lacking.
Dextromethorphan/Quinidine
TLDR
The drug has been shown to cause dosage-dependent corrected QT interval (QTc) prolongation; however, in the STAR trial, dextromethorphan/quinidine 20mg/10mg twice daily appeared to be well tolerated with regard to QTc prolongation.
Dextromethorphan/quinidine for pseudobulbar affect
Dextromethorphan/quinidine (DM/Q; NUEDEXTA) is approved by the US FDA for the treatment of pseudobulbar affect (PBA) associated with chronic neurological disorders such as multiple sclerosis, stroke,…
Treatment of pseudobulbar affect in ALS
Dextromethorphan/quinidine sulfate for pseudobulbar affect.
TLDR
DM/Q was recently shown to be effective in reducing the severity of PBA in two large studies of ALS and multiple sclerosis, which are probably the most common neurological settings, and the agent was safe and relatively well tolerated.
An open-label multicenter study to assess the safety of dextromethorphan/quinidine in patients with pseudobulbar affect associated with a range of underlying neurological conditions
TLDR
DM/Q was generally well tolerated over this 52 week trial in patients with PBA associated with a wide range of neurological conditions, and differences in AEs across neurological disease groups appeared consistent with the known morbidity of the primary neurological conditions.
Therapeutic use of dextromethorphan: Key learnings from treatment of pseudobulbar affect
Evaluating the safety and efficacy of dextromethorphan/quinidine in the treatment of pseudobulbar affect
TLDR
The use of DM/Q in the treatment of PBA is supported by three published efficacy and safety studies; significant effects were seen on the primary end point, the Center for Neurologic Study-Lability Scale, as well as secondary efficacy end points and quality of life.
Review of Dextromethorphan 20 mg/Quinidine 10 mg (NUEDEXTA®) for Pseudobulbar Affect
  • E. Pioro
  • Medicine, Psychology
    Neurology and Therapy
  • 2014
TLDR
Dextromethorphan (DM) hydrobromide combined with quinidine sulfate (Q) as treatment of PBA is described and the ongoing debates concerning the terminology for dysfunction of emotional expression, as well as the ongoing searches for its brain substrates are surveyed.
Current Concepts in the Pharmacotherapy of Pseudobulbar Affect
TLDR
Across all placebo-controlled trials, response to active treatment — either an antidepressant or dextromethorphan/quinidine — has in general been significantly greater than response to placebo, but placebo response has sometimes been substantial, suggesting caution in interpreting uncontrolled findings.
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