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.
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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.
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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.
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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.
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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.
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TLDR
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PRISM II: an open-label study to assess effectiveness of dextromethorphan/quinidine for pseudobulbar affect in patients with dementia, stroke or traumatic brain injury
TLDR
DM/Q was shown to be an effective and well-tolerated treatment for PBA secondary to dementia, stroke, or TBI and the adverse event profile was consistent with the known safety profile of DM/Q.
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