Nuedexta

NMDA Receptor Antagonist / Antiarrhythmic Combinations

DEXTROMETHORPHAN; QUINIDINE is a combination of two medicines used to treat pseudobulbar affect (PBA), a condition that causes uncontrollable, sudden, and frequent episodes of laughing and/or crying.


Commonly Used Brand Name(s): Nuedexta

Therapeutic Classification: Central Nervous System Agent

Chemical Classification: Quinidine

Dextromethorphan and quinidine combination is used to treat a rare condition called pseudobulbar affect (PBA) or emotional incontinence. PBA is a nervous system disorder that is characterized by uncontrollable, sudden, and frequent episodes of crying or laughing.

This medicine is available only with your doctor's prescription.

Take this medicine exactly as directed by your doctor. Do not take more of it, do not take it more often, and do not take it for a longer time than your doctor ordered. To do so may increase the chance of side effects.

Grapefruits and grapefruit juice may increase the effects of dextromethorphan and quinidine combination by increasing the amount of this medicine in your body. You should not eat grapefruit or drink grapefruit juice while you are taking this medicine.

Dosing

The dose of this medicine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

  • For oral dosage form (capsules):
    • For PBA or emotional incontinence:
      • Adults—One capsule once a day for the first 7 days of treatment. Then on day 8 and onwards, dose should be two capsules per day, taken as one capsule every 12 hours. Each capsule contains 20 milligrams (mg) of dextromethorphan and 10 mg of quinidine.
      • Children—Use and dose must be determined by your doctor.

Missed Dose

If you miss a dose of this medicine, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.

Storage

Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing.

Keep out of the reach of children.

Do not keep outdated medicine or medicine no longer needed.

Ask your healthcare professional how you should dispose of any medicine you do not use.

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For this medicine, the following should be considered:

Allergies

Tell your doctor if you have ever had any unusual or allergic reaction to this medicine or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.

Pediatric

Appropriate studies have not been performed on the relationship of age to the effects of dextromethorphan and quinidine combination in the pediatric population. Safety and efficacy have not been established.

Geriatric

Appropriate studies performed to date have not demonstrated geriatric-specific problems that would limit the usefulness of dextromethorphan and quinidine combination in the elderly.

Pregnancy

Pregnancy CategoryExplanation
All TrimestersCAnimal studies have shown an adverse effect and there are no adequate studies in pregnant women OR no animal studies have been conducted and there are no adequate studies in pregnant women.

Breast Feeding

Studies in women suggest that this medication poses minimal risk to the infant when used during breastfeeding.

Drug Interactions

Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using this medicine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.

Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

Other Interactions

Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using this medicine with any of the following may cause an increased risk of certain side effects but may be unavoidable in some cases. If used together, your doctor may change the dose or how often you use this medicine, or give you special instructions about the use of food, alcohol, or tobacco.

  • Grapefruit Juice

Medical Problems

The presence of other medical problems may affect the use of this medicine. Make sure you tell your doctor if you have any other medical problems, especially:

  • Bone marrow problems caused by quinidine, quinine, or mefloquine, history of or
  • Heart block without a pacemaker or
  • Heart failure or
  • Heart rhythm problems (e.g., congenital long QT syndrome, prolonged QT interval, or a history of torsade de pointes) or
  • Hepatitis caused by quinidine, quinine, or mefloquine, history of or
  • Lupus-like syndrome caused by quinidine, quinine, or mefloquine, history of or
  • Thrombocytopenia (low platelets in the blood) caused by quinidine, quinine, or mefloquine, history of—Should not be used in patients with these conditions.
  • Drug abuse or dependence, or history of—Dependence may be more likely to develop.
  • Kidney disease, severe or
  • Liver disease, severe—Higher blood levels of this medicine can occur, which increases the risk of serious side effects.
  • Myasthenia gravis (severe muscle weakness)—Use with caution. May make this condition worse.

It is very important that your doctor check your progress at regular visits. This will allow your doctor to see if the medicine is working properly and to decide if you should continue to take it. Blood tests may be needed to check for unwanted effects.

If your symptoms do not improve or if they become worse, check with your doctor.

Do not use this medicine together with other products containing quinidine, quinine (Qualaquin®), or mefloquine (Lariam®). You should not take this medicine if you are also using pimozide (Orap®), thioridazine (Mellaril®), or an MAO inhibitor (MAOI) such as Eldepryl®, Marplan®, Nardil®, or Parnate® within the past 14 days. Also, allow at least 14 days after stopping this medicine before starting an MAO inhibitor (MAOI).

Stop using this medicine and check with your doctor right away if you have the following symptoms while taking this medicine: black, tarry stools; bleeding gums; blood in the urine or stools; chills; fever; lightheadedness; nausea or vomiting; pinpoint red spots on the skin; or unusual bleeding or bruising.

This medicine can cause changes in heart rhythms, such as a condition called QT prolongation. It may change the way your heart beats and cause fainting or serious side effects in some patients. Contact your doctor right away if you have any symptoms of heart rhythm problems, such as fast, pounding, or irregular heartbeats.

This medicine may cause some people to become dizzy, trouble in controlling movements, or less alert than they are normally. Make sure you know how you react to this medicine before you drive, use machines, or do other jobs that require you to be alert and well-coordinated.

Make sure your doctor knows about all the other medicines you are using. This medicine may cause a serious condition called serotonin syndrome when taken with medicine for depression (such as amitriptyline, clomipramine, doxepin, fluoxetine, imipramine, nortriptyline, Anafranil®, Elavil®, Prozac®, Sinequan®, or Tofranil®). Check with your doctor first before taking any other medicines.

This medicine will add to the effects of alcohol and other CNS depressants (medicines that make you drowsy or less alert). Some examples of CNS depressants are antihistamines or medicine for hay fever, allergies, or colds; sedatives, tranquilizers, or sleeping medicine; prescription pain medicine or narcotics; other medicines for seizures (e.g., barbiturates); muscle relaxants; or anesthetics, including some dental anesthetics. Check with your medical doctor or dentist before taking any of the above while you are using this medicine.

Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal or vitamin supplements.

They need to know if you have any of these conditions:

Take this medicine by mouth with a glass of water. Follow the directions on the prescription label. You can take it with or without food. If it upsets your stomach, take it with food. Take your medicine at regular intervals. Do not take it more often than directed. Do not stop taking except on your doctor's advice.

Talk to your pediatrician regarding the use of this medicine in children. Special care may be needed.

Overdosage: If you think you've taken too much of this medicine contact a poison control center or emergency room at once.

If you miss a dose, take it as soon as you can. If it is almost time for your next dose, take only that dose. Do not take double or extra doses.

Keep out of the reach of children.

Store at room temperature between 15 and 30 degrees C (59 and 86 degrees F). Throw away any unused medicine after the expiration date.

Copyright ©2014 GoodRx, Inc.

GoodRx is not sponsored by or affiliated with any of the pharmacies identified in its price comparisons. All trademarks referenced are the trademarks of their respective owners. This information is for informational purposes only and is not meant to be a substitute for professional medical advice, diagnosis or treatment. GoodRx is not offering advice, recommending or endorsing any specific prescription drug, pharmacy or other information on the site. GoodRx provides no warranty for any of the pricing data or other information. Please seek medical advice before starting, changing or terminating any medical treatment.

The information contained in the Truven Health Micromedex products as delivered by GoodRx is intended as an educational aid only. It is not intended as medical advice for individual conditions or treatment. It is not a substitute for a medical exam, nor does it replace the need for services provided by medical professionals. Talk to your doctor, nurse or pharmacist before taking any prescription or over the counter drugs (including any herbal medicines or supplements) or following any treatment or regimen. Only your doctor, nurse, or pharmacist can provide you with advice on what is safe and effective for you.

The use of the Truven Health products is at your sole risk. These products are provided "AS IS" and "as available" for use, without warranties of any kind, either express or implied. Truven Health and GoodRx make no representation or warranty as to the accuracy, reliability, timeliness, usefulness or completeness of any of the information contained in the products. Additionally, TRUVEN HEALTH MAKES NO REPRESENTATION OR WARRANTIES AS TO THE OPINIONS OR OTHER SERVICE OR DATA YOU MAY ACCESS, DOWNLOAD OR USE AS A RESULT OF USE OF THE THOMSON REUTERS HEALTHCARE PRODUCTS. ALL IMPLIED WARRANTIES OF MERCHANTABILITY AND FITNESS FOR A PARTICULAR PURPOSE OR USE ARE HEREBY EXCLUDED. Truven Health does not assume any responsibility or risk for your use of the Truven Health products.