Concomitant use w/ quinidine, quinine, or mefloquine; h/o quinidine, quinine or mefloquine-induced TCP, hepatitis, or other hypersensitivity rxns, or w/ known hypersensitivity to DXM; use w/ an MAOI or within 14 days of stopping an MAOI; ↑'d QT interval, congenital LQTS, h/o TdP or HF, complete AV block w/o ICD concomitant use with drugs that both ↑ QT and are 2D6 substrates (e.g., thioridazine or pimozide)
Serious Side Effects: ↑'d risk of serotonin syndrome when coadminsitered w/ other serotonergic agents; TCP or other hypersensitivity reactions; hepatitis; QT↑; LVH or LVD Known Risk of TdP (quinidine)
Side Effects: dizziness, diarrhea, diarrhea, anticholinergic side effects, peripheral edema, flatulence, cough
1° MOA: Uncompetitive NMDA Receptor Antagonist & σ1R Agonist 2° MOA: Quinidine ↑'s DXM bioavailability by competitively inhibiting CYP2D6 (which glucuronidates DXM to dextrorphan, which cannot cross the blood-brain barrier) Target: NMDA,
watch for pharmacodynamic interactions (i.e. 5HT syndrome) when co-prescribed w/ other serotonergic agents
- PBA is manifested by involuntary labile, shallow affect with sudden and unpredictable laughing, crying, or other emotional displays that are not appropriate to the social setting and may not be congruent with the patient's prevailing mood
the pathophysiology of PBA may involve excessive release of glutamate by injured neurons, disrupting systems for motor control of emotional expression
the reported prevalence of PBA is 49% in ALS, 18-39% in Alzheimer's disease, 11-34% in CVA &10-11% in MS & TBI
Category Undefined.—Both quinidine & DXM are considered to be compatible with pregnancy
DXM is considered to be compatible with breastfeeding; the American Academy of Pediatrics has classified quinidine as compatible with breastfeeding
The pharmacokinetics of dextromethorphan/quinidine have not been investigated systematically in elderly subjects
Dose adjustment is not required in mild or moderate renal impairment. Has not been studied in patients with severe renal impairment.
Mild to moderate hepatic impairment had little effect on quinidine pharmacokinetics. Neither dextromethorphan alone nor NUEDEXTA has been evaluated in patients with severe hepatic impairment.
Developed & Designed by Kevin M. Nasky, D.O. • Built with Bootstrap, PHP & MySQL • Hosted by SiteGround
Last updated June 10 2018 15:40:14. Disclaimer: This website does not provide medical advice, nor is it a substitute for clinical judgment.
Think before you use this website!
Psychopharmacopeia.com includes clinical information intended for use by healthcare professionals. This does not constitute as clinical or professional advice. Physicians and other healthcare professionals should always use their own clinical judgment first and follow laws and guidelines in their own practice jurisdiction. Psychopharmacopeia.com does not give medical advice or diagnostic services. Neither we nor our content providers can guarantee that the content covers all possible uses, directions, precautions, drug interactions, or adverse effects that may be associated with any therapeutic treatments.
Non-health care providers who use this website, please do so at your own risk, and always seek professional medical advice. I have done my best to ensure that the information on this website is reliable, but neither we nor our content providers guarantee the accuracy of the information contained on this site.
Use this site at your own risk. Psychopharmacopeia.com and its hosting provider do not assume any liability or responsibility for damage, injury, or death to you, other persons or property from any use of any ideas, information, or instruction in this website.