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Nuedexta Coupon - Nuedexta 20mg/10mg capsule

Nuedexta

dextromethorphan / quinidine
Used for Multiple Sclerosis, ALS
Used for Multiple Sclerosis, ALS

Nuedexta (dextromethorphan / quinidine) is taken by adults to treat pseudobulbar affect (PBA), a condition where there's uncontrollable laughing or crying. It's a combination medication containing a sigma-1 receptor agonist and N-methyl-D-aspartate (NMDA) antagonist (dextromethorphan) and an antiarrhythmic (quinidine). Nuedexta (dextromethorphan / quinidine) is typically taken by mouth twice a day. Some common side effects of this medication include diarrhea, dizziness, and cough.

Reviewed by:
reviewer
Robert Chad Hakim, PharmD, BCCCP
reviewer
Connie Zheng, PharmD
Last reviewed on January 21, 2024
BasicsSide effectsPros & consPharmacist tipsFAQsWarningsDosageInteractionsCostContraindicationsAlternativesLatest newsImagesReferencesPricesMedicare
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What is Nuedexta (dextromethorphan / quinidine)?

What is Nuedexta (dextromethorphan / quinidine) used for?

  • Pseudobulbar affect (PBA) in adults

How Nuedexta (dextromethorphan / quinidine) works

Nuedexta (dextromethorphan / quinidine) is a combination of two medications that work together:

  • Dextromethorphan is a sigma-1 receptor agonist and NMDA antagonist. It's not completely clear how exactly it works to treat PBA. But it's thought to balance out certain chemicals in the brain that affect mood and behavior.

  • Quinidine is an antiarrhythmic. But it's role in Nuedexta is to prevent dextromethorphan from being broken down too quickly in the body.

Are you looking for information on quinidine or dextromethorphan (Delsym) instead?

Drug Facts

Common BrandsNuedexta
Drug ClassNMDA antagonist
Controlled Substance ClassificationNot a controlled medication
Generic StatusNo lower-cost generic available
AvailabilityPrescription only
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What are the side effects of Nuedexta (dextromethorphan / quinidine)?

The following side effects may get better over time as your body gets used to the medication. Let your healthcare provider know immediately if you continue to experience these symptoms or if they worsen over time.

Common Side Effects

  • Diarrhea (13%)
  • Dizziness (10%)
  • Cough (5%)
  • Vomiting (5%)
  • Weakness, lack of energy (5%)
  • Swelling in your hands and feet (5%)

Other Side Effects

  • Bladder infection (UTI)
  • Flu
  • Passing gas

Serious Side Effects

Contact your healthcare provider immediately if you experience any of the following.
  • Low platelets: lightheaded, fever, chills, nausea, vomiting, skin that bruises easily, purple or red pinpoint spots on skin, bleeding that's difficult to stop, bleeding in your gums or nose, blood in the urine
  • Serotonin syndrome: fast heart rate, dizziness, sweating, flushing, tremor (shakiness), muscle stiffness, muscle twitching or spasms, uncoordinated movement, distress, seizures, distress, hallucinations, coma
  • Liver damage: severe stomach pain, yellowing of skin or whites of the eyes, nausea, vomiting, loss of appetite
  • Abnormal heart rhythm (QT prolongation): chest pounding, short of breath, chest pain, feeling faint or lightheaded

Source: DailyMed

The following side effects have also been reported

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if any of the following side effects occur:

Less common

Bladder pain

bloating or swelling of the face, arms, hands, lower legs, or feet

bloody or cloudy urine

chills

cough

diarrhea

difficult, burning, or painful urination

fever

frequent urge to urinate

general feeling of discomfort or illness

headache

joint pain

loss of appetite

lower back or side pain

muscle aches and pains

nausea

rapid weight gain

runny nose

shivering

sore throat

sweating

tingling of the hands or feet

trouble sleeping

unusual tiredness or weakness

unusual weight gain or loss

vomiting

Get emergency help immediately if any of the following symptoms of overdose occur:

Symptoms of overdose

Aggressive and violent behavior

agitation

blurred vision

change in color vision

change in consciousness

chest pain or discomfort

confusion

confusion as to time, place, or person

continuing ringing or buzzing or other unexplained noise in the ears

decreased awareness or responsiveness

depression

difficulty seeing at night

dizziness or lightheadedness

dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position

double vision

excitement

fainting

fast, pounding, or irregular heartbeat or pulse

feeling of constant movement of self or surroundings

hallucinations

hearing loss

holding false beliefs that cannot be changed by fact

inability to move the eyes

increased blinking or spasms of the eyelid

increased sensitivity of the eyes to sunlight

irregular or slow heart rate

loss of consciousness

overactive reflexes

poor coordination

restlessness

seeing double

seizures

sensation of spinning

severe sleepiness

shakiness and unsteady walk

shivering

shortness of breath

sticking out of tongue

sweating

talking or acting with excitement you cannot control

trembling or shaking

trouble with breathing, speaking, or swallowing

twitching

uncontrolled eye movements

uncontrolled twisting movements of the neck, trunk, arms, or legs

unsteadiness, trembling, or other problems with muscle control or coordination

unusual excitement, nervousness, or restlessness

unusual facial expressions

Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

Less common

Bloated

excess air or gas in the stomach or intestines

full feeling

lack or loss of strength

passing gas

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

pros-and-cons

Pros and cons of Nuedexta (dextromethorphan / quinidine)

thumbs-up

Pros

Can lower the number of PBA episodes per day by about half

Taken by mouth

Can be taken with or without food

thumbs-down

Cons

Taken twice per day

Hasn't been well-studied in pregnancy or during nursing

Not a good option for people with certain heart conditions

pharmacist-tips

Pharmacist tips for Nuedexta (dextromethorphan / quinidine)

pharmacist

  • Take Nuedexta (dextromethorphan / quinidine) about the same times every day. You can take Nuedexta (dextromethorphan / quinidine) with or without food.

    • Some of the more common side effects of Nuedexta (dextromethorphan / quinidine) include diarrhea and vomiting. If you're experiencing these side effects, make sure to drink enough fluids so you don't become dehydrated. In addition, eat smaller meals (that are easy to digest) more often throughout the day, instead of 3 larger meals, to try to ease these symptoms.

      • Dizziness is a common side effect Nuedexta (dextromethorphan / quinidine). Don't drive or do anything requires a lot of focus until you know how Nuedexta (dextromethorphan / quinidine) affects you. Also, avoid drinking alcohol while taking this medication because doing so can worsen dizziness.

        • Let your provider know you're taking Nuedexta (dextromethorphan / quinidine) before you start any new medications, including over-the-counter (OTC) medications and herbal supplements. This medication can interact with many medications and can't be taken with some, such as quinine (Qualaquin), certain antidepressants (e.g., MAOIs, SSRIs, etc.), and digoxin (Lanoxin).

          • Dextromethorphan, is found in many over-the-counter medication for the treatment of cough. Don't take Nuedexta (dextromethorphan / quinidine) with other dextromethorphan-containing medications because this can raise your risk for severe side effects (e.g., serotonin syndrome, dizziness).

            • Nuedexta (dextromethorphan / quinidine) hasn't been well-studied in pregnancy or during breastfeeding. But animal studies suggest it can harm babies if taken by mothers during pregnancy. If you're pregnant, thinking of becoming pregnant, or are breastfeeding, talk to your provider about your options for PBA.

              faqs

              Frequently asked questions about Nuedexta (dextromethorphan / quinidine)

              Is Nuedexta (dextromethorphan / quinidine) an antipsychotic?
              No, Nuedexta (dextromethorphan / quinidine) isn't an antipsychotic medication; it's a combination medication that has dextromethorphan (sigma-1 receptor agonist and NMDA receptor antagonist) and quinidine (an antiarrhythmic).
              Is Nuedexta (dextromethorphan / quinidine) a controlled substance?
              No, Nuedexta (dextromethorphan / quinidine) isn't a controlled substance.
              Can Nuedexta (dextromethorphan / quinidine) be crushed or opened?
              No, don't crush or open the Nuedexta (dextromethorphan / quinidine) capsules. The manufacturer of Nuedexta (dextromethorphan / quinidine) doesn't give instructions for opening or crushing the capsules. Doing so can damage the medication, cause side effects, or make it not work as well for you. If you're having trouble swallowing the Nuedexta (dextromethorphan / quinidine) capsules, talk to your provider.
              Can Nuedexta (dextromethorphan / quinidine) be stopped abruptly?
              Don't stop taking Nuedexta (dextromethorphan / quinidine) without talking to your provider first because doing so can cause your PBA symptoms to come back. But if you need to stop taking Nuedexta (dextromethorphan / quinidine), it's unlikely that your provider will need to lower your dose slowly over time as this medication isn't known to cause withdrawal symptoms.
              Does Nuedexta (dextromethorphan / quinidine) cause weight gain?
              No, Nuedexta (dextromethorphan / quinidine) doesn't typically cause weight gain or weight loss. Contact your provider if you notice significant changes in weight while taking Nuedexta (dextromethorphan / quinidine).
              How long does it take for Nuedexta (dextromethorphan / quinidine) to work?
              You might notice less crying or laughing episodes after about 2 weeks of treatment with Nuedexta (dextromethorphan / quinidine). But some people will need to take it longer to see a more noticeable improvement. Nuedexta (dextromethorphan / quinidine) takes time to work and different people respond to this medication differently. Talk with your provider if you're concerned with how well Nuedexta (dextromethorphan / quinidine) is working for you.
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              What are the risks and warnings for Nuedexta (dextromethorphan / quinidine)?

              Nuedexta (dextromethorphan / quinidine) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.

              risk-warning

              Low platelets and allergic reactions

              • Risk factors: Previous reaction to quinine or mefloquine

                Some people can have life-threatening allergic reactions with quinidine, one of the medications in Nuedexta (dextromethorphan / quinidine). It's more common in anyone who's had a reaction to quinine (Qualaquin) or mefloquine in the past because these medications are similar to quinidine. In some cases, your immune system will start to attack your platelets and cause a dangerously low platelet levels (called thrombocytopenia). Symptoms include feeling lightheaded, fever, chills, nausea, and vomiting. Rarely, having low platelet levels can cause bleeding that's difficult to stop.

                In other cases, Nuedexta (dextromethorphan / quinidine) can cause lupus-like symptoms, such as arthritis in multiple joints, rash, and muscle aches. Contact your provider if you experience any of these symptoms because you might need to stop this medication. Make sure you're making regular appointments with your healthcare provider and getting any blood tests done.

                risk-warning

                Liver damage

                Rarely, people taking Nuedexta (dextromethorphan / quinidine) can experience hepatitis (inflammation of the liver) and liver damage. In clinical studies, this side effect was seen typically in the first few weeks and went away on its own when the medication was stopped. Contact your provider if you have symptoms such as fever, tiredness, nausea, stomach pain, or yellowing of your eyes and skin.

                risk-warning

                Life-threatening abnormal heart rhythm

                • Risk factors: Low blood potassium or magnesium levels | Older age | Heart rhythm or other heart problems | Family history of long QT syndrome | Taking other medications that cause QT prolongation | Taking high doses of Nuedexta (dextromethorphan / quinidine)

                  Nuedexta (dextromethorphan / quinidine) can affect the time it takes for your heart to pump and then relax. This is known as QT prolongation. Your risk for QT prolongation is higher if you have certain factors, including abnormal electrolyte levels and heart rhythm problems. Your risk is also higher if you're taking other medications that cause heart rhythm problems, such as amiodarone (Pacerone) and quetiapine (Seroquel), among others. If you're at higher risk for heart rhythm problems, your provider will likely check your heart rhythm at the beginning of treatment. If you feel your chest pounding, have shortness of breath, have chest pain, or feel faint or lightheaded while taking Nuedexta (dextromethorphan / quinidine), call 911 right away.

                  risk-warning

                  Dizziness

                  • Risk factors: Difficulty walking or history of falls

                    Nuedexta (dextromethorphan / quinidine) can make you feel dizzy. Take care to lower your risk of falling, especially if you have a history of falls. Some examples include avoiding alcohol while you're taking Nuedexta (dextromethorphan / quinidine) and standing up slowly from a seated position.

                    risk-warning

                    Serotonin syndrome

                    • Risk factors: Taking monoamine oxidase inhibitors (MAOI) 14 days before starting Nuedexta (dextromethorphan / quinidine) | Taking other medications that raise serotonin levels in your brain

                      Serotonin syndrome is a rare, but potentially life-threatening condition where there's too much serotonin in the brain. Serotonin is one of the chemicals in your brain responsible for your mood. Your risk for this condition goes up if you use Nuedexta (dextromethorphan / quinidine) with other medications that affect serotonin levels, such as antidepressants (e.g., sertraline (Zoloft), duloxetine (Cymbalta)), MAOIs (e.g., phenelzine (Nardil)), lithium, and certain migraine medications (e.g., sumatriptan (Imitrex)). Make sure your provider knows about all the medications you take (including over-the-counter medications and supplements) before starting Nuedexta (dextromethorphan / quinidine) so they can check that your medications are safe for you. Symptoms of serotonin syndrome include fast heart rate, sweating, muscle stiffness or spasms, high fever, and confusion. Get medical help right away if you have any of these symptoms.

                      dosage

                      Nuedexta (dextromethorphan / quinidine) dosage forms

                      The average cost for 60 capsules of 20mg/10mg of Nuedexta (dextromethorphan / quinidine) is $1519.79 with a free GoodRx coupon. This is 20.47% off the average retail price of $1911.04.
                      capsule
                      Capsule
                      DosageQuantityPrice as low asPrice per unit
                      20mg/10mg60 capsules$1519.79$25.33

                      Typical dosing for Nuedexta (dextromethorphan / quinidine)

                      Each Nuedexta (dextromethorphan / quinidine) capsule contains 20 mg of dextromethorphan and 10 mg of quinidine.

                      • Adults: The typical starting dose is 1 capsule by mouth once a day for 7 days. Then on day 8, the dose is 1 capsule by mouth every 12 hours.

                      interactions

                      Interactions between Nuedexta (dextromethorphan / quinidine) and other drugs

                      Nuedexta (dextromethorphan / quinidine) may interact with certain medications or supplements. Always let your doctor and pharmacist know about any other medications or supplements (including prescribed and over-the-counter medications, vitamins, and dietary or herbal supplements) that you are currently taking. The list below does not include all possible drug interactions with Nuedexta (dextromethorphan / quinidine). Please note that only the generic name of each medication is listed below.

                      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.

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                      How much does Nuedexta (dextromethorphan / quinidine) cost?

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                      contraindications-icon

                      Nuedexta (dextromethorphan / quinidine) contraindications

                      Contraindications are specific health conditions or situations in which a person should not take a medication due to safety concerns. If you have any of the following conditions or if any of the following apply to you, let your healthcare provider know because Nuedexta (dextromethorphan / quinidine) will not be safe for you to take.

                      • Taking quinine, quinidine, mefloquine, and any medications that cause QT prolongation

                      • Currently take or have taken a MAOI within the last 2 weeks

                      • History of allergic reaction, hepatitis, or low platelets caused by quinidine, quinine, or mefloquine

                      • Certain heart conditions, including heart failure, QT prolongation, AV block without pacemaker

                      alternatives

                      What are alternatives to Nuedexta (dextromethorphan / quinidine)?

                      There are a number of medications that your doctor can prescribe in place of Nuedexta (dextromethorphan / quinidine). Compare a few possible alternatives below.
                      Nuedexta (dextromethorphan / quinidine)
                      Used for:

                      • Pseudobulbar affect (PBA) in adults

                      $1519.79 Lowest GoodRx priceView Prices
                      Amitriptyline
                      Used for:

                      • Depression

                      $4.00 Lowest GoodRx priceView Prices
                      Paroxetine (Paxil)
                      Used for:
                      $10.00 Lowest GoodRx priceView Prices
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                      Nuedexta (dextromethorphan / quinidine) images

                      Red Dmq 20-10 - NUEDEXTA 20mg-10mg Capsule
                      This medicine is Red Capsule Imprinted With "Dmq 20-10".Red Dmq 20-10 - NUEDEXTA 20mg-10mg Capsule
                      Red Dmq 20-10 - NUEDEXTA 20mg-10mg Capsule
                      This medicine is Red Capsule Imprinted With "Dmq 20-10".Red Dmq 20-10 - NUEDEXTA 20mg-10mg Capsule

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                      References

                      Best studies we found

                      Ahmed, A., et al. (2013). Pseudobulbar affect: Prevalence and management. Therapeutics and Clinical Risk Management.

                       Al-Khatib, S. M., et al. (2003). What clinicians should know about the QT interval. Journal of the American Medical Association.

                      Avanir Pharmaceuticals, Inc. (2019). Nuedexta- dextromethorphan hydrobromide and quinidine sulfate capsule, gelatin coated [package insert]. DailyMed.

                      View All References (4)

                      Chen, J. J. (2017). Pharmacotherapeutic management of pseudobulbar affect. American Journal of Managed Care.

                      Cruz, M. P. (2013). Nuedexta for the treatment of pseudobulbar affect: A condition of involuntary crying or laughing. Pharmacy and Therapeutics.

                      Miller, A., et al. (2014). Pseudobulbar affect: The spectrum of clinical presentations, etiologies and treatments. Expert Review of Neurotherapeutics.

                      Pioro, E. P., et al. (2010). Dextromethorphan plus ultra low-dose quinidine reduces pseudobulbar affect. Annals of Neurology.

                      GoodRx Health has strict sourcing policies and relies on primary sources such as medical organizations, governmental agencies, academic institutions, and peer-reviewed scientific journals. Learn more about how we ensure our content is accurate, thorough, and unbiased by reading our editorial guidelines.
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