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Combination of
DextromethorphanSigma-1 receptor agonist, NMDA receptor antagonist
QuinidineAntiarrhythmic agent
Trade namesNuedexta
Other namesAVP-786, AVP-923
Clinical data
  • US: C (Risk not ruled out)[1]
Routes of
By mouth
External links
US NLMDextromethorphan/quinidine
License data
Legal status
  • US: ℞-only
  • In general: ℞ (Prescription only)
Bioavailabilitydextromethorphan 11%, quinidine 70-80%. Food has no effect on absorption.
MetabolismLiver, extensive. Dextromethorphan is catalyzed by CYP2D6. Quinidine is metabolized by CYP3A4 and competitively inhibits the metabolism of dextromethorphan to increase and prolong plasma concentrations of dextromethorphan
Elimination half-lifedextromethorphan 13h, quinidine 7h
Excretionquinidine 5-20%

Dextromethorphan/quinidine, sold under the brand name Nuedexta, is a combination medication used to treat pseudobulbar affect (PBA).[2]

It contains dextromethorphan and the class I antiarrhythmic agent quinidine.[2]

Dextromethorphan/quinidine was approved for medical use in the United States in October 2010, and is marketed by Avanir Pharmaceuticals.[3]


  • Atrioventricular (AV) block, complete, without implanted pacemaker or at high risk of complete AV block
  • Concomitant use with drugs containing quinidine, quinine, or mefloquine
  • Concomitant use with drugs that both prolong the QT interval and are metabolized by CYP2D6 (e.g., thioridazine, pimozide); effects on QT interval may be increased
  • Concomitant use with MAOIs or use of MAOIs within 14 days; risk of serious, potentially fatal, drug interactions including serotonin syndrome
  • Heart failure
  • Hypersensitivity to dextromethorphan
  • Hypersensitivity to quinine, mefloquine, quinidine, or dextromethorphan/quinidine with a history of thrombocytopenia, hepatitis, bone marrow depression or lupus-like syndrome induced by these drugs
  • QT interval, prolonged or congenital long QT syndrome or a history suggesting torsades de pointes

Side effects

Common risks and side effects include:[2]



In June 2012, drug discovery and development magazine reported that Avanir Pharmaceuticals plans to test the drug for the treatment of agitation associated with Alzheimer's disease.[4] The drug is also under investigation for the treatment of major depressive disorder.[1][5] As of May 2021, the drug is also in clinical trial for negative symptoms of schizophrenia.[6]

See also


  1. "Dextromethorphan / quinidine (Nuedexta) Use During Pregnancy". 21 August 2019. Retrieved 13 September 2020.
  2. 2.0 2.1 2.2 2.3 2.4 "Nuedexta- dextromethorphan hydrobromide and quinidine sulfate capsule, gelatin coated". DailyMed. 23 June 2019. Retrieved 23 October 2020.
  3. "Drug Approval Package: Nuedexta (dextromethorphan hydrobromide and quinidine sulfate) Capsules NDA #021879". U.S. Food and Drug Administration (FDA). 24 December 1999. Retrieved 23 October 2020. Lay summary (PDF).
  4. "NNuedexta Testing New Indication". CDrug Discovery and Development Magazine. June 13, 2011.
  5. Nguyen, Linda; Thomas, Kelan L.; Lucke-Wold, Brandon P.; Cavendish, John Z.; Crowe, Molly S.; Matsumoto, Rae R. (2016). "Dextromethorphan: An update on its utility for neurological and neuropsychiatric disorders". Pharmacology & Therapeutics. 159: 1–22. doi:10.1016/j.pharmthera.2016.01.016. ISSN 0163-7258. PMID 26826604.
  6. Avanir Pharmaceuticals (2021-04-26). "A Multicenter, Randomized, Double-blind, Placebo-controlled, Parallel-arm Study to Assess the Efficacy, Safety, and Tolerability of AVP-786 (Deudextromethorphan Hydrobromide [d6-DM]/Quinidine Sulfate [Q]) for the Treatment of Negative Symptoms of Schizophrenia". Cite journal requires |journal= (help)

External links