Dextromethorphan/quinidine for the treatment of pseudobulbar affect.
OBJECTIVE
To evaluate the role of dextromethorphan/quinidine (DM/Q; Nuedexta™) in the treatment of pseudobulbar affect (PBA).


METHODS
A literature search of MEDLINE/PubMed (January 1966-June 2013) was conducted using search terms pseudobulbar affect, pathological laughing and/or crying, emotional lability, dextromethorphan, and quinidine.


METHODS
English language clinical trials and case reports evaluating the safety and efficacy of DM/Q in PBA were included for review. Bibliographies of all relevant articles were reviewed for additional citations.


RESULTS
PBA, a poorly understood disorder, is characterized by involuntary crying and/or laughing. In the past, antidepressants and antiepileptics have been used off-label with mixed results. Four clinical trials have evaluated the use of DM/Q for the treatment of PBA. Although the therapeutic outcomes with DM/Q have been positive, interpretation of the published evidence is limited by small sample size and short treatment duration.


CONCLUSIONS
Based on the data available, DM/Q may be a viable, short-term treatment alternative for PBA. Long-term safety and efficacy data are lacking.
College of Pharmacy, Southwestern Oklahoma State University, Weatherford, Oklahoma.
Edna
E
Patatanian
M & D Star Drug.
Jessica
J
Casselman
D002986:Clinical Trials as Topic; D003448:Crying / Q000523:psychology; D003915:Dextromethorphan / Q000008:administration & dosage / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D004338:Drug Combinations; D018691:Excitatory Amino Acid Antagonists / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D007845:Laughter / Q000523:psychology; D020828:Pseudobulbar Palsy / Q000188:drug therapy* / Q000378:metabolism / Q000523:psychology; D011802:Quinidine / Q000008:administration & dosage / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D017480:Receptors, sigma / Q000819:agonists*; D016896:Treatment Outcome; D000097605:Sigma-1 Receptor
D003915:Dextromethorphan; D004338:Drug Combinations; D018691:Excitatory Amino Acid Antagonists; D011802:Quinidine; D017480:Receptors, sigma; D000097605:Sigma-1 Receptor; C507057:dextromethorphan - quinidine combination
AD = Alzheimer's disease; AE = Adverse effect; ALS = Amyotrophic lateral sclerosis; Antidepressants; CNS-LS = Center for Neurologic Study Lability Scale; CYP = Cytochrome; DM/Q = Dextromethorphan/quinidine; Dextromethorphan; Emotional lability; FDA = Food and Drug Administration; ICD = International Classification of Diseases; MS = Multiple sclerosis; NMDA = N-methyld-aspartate; PBA = Pseudobulbar affect; PD = Parkinson's disease; PLACS = Pathological Laughing and Crying Scale; PLC = Pathological laughing or crying; Pathological laughing and crying; Pseudobulbar affect; Quinidine; SSRIs = Selective serotonin reuptake inhibitors; TBI = Traumatic brain injury; TCAs = Tricyclic antidepressants