Auvelity

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Attending1985

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a pharmacist at my clinic was asking me about this medication today. Why isn’t it a scheduled medication. I saw plenty of dextramethorphan abuse as a resident.
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Attending1985 said:
a pharmacist at my clinic was asking me about this medication today. Why isn’t it a scheduled medication. I saw plenty of dextramethorphan abuse as a resident.
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Wat? You can walk into any pharmacy in this country and buy a bottle of dextromethorphan. So yeah...neither med component is scheduled which is why it isn't scheduled.

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My thoughts are that the only way this “new” drug makes money is if it actually does get people high. Is there any evidence or theory behind dextromethorphan improving the efficacy of bupropion? Maybe the drug company already knows that this might be popular to abuse and they could cash in on that. I don’t know why I don’t trust these guys. 🤔
 
smalltownpsych said:
My thoughts are that the only way this “new” drug makes money is if it actually does get people high. Is there any evidence or theory behind dextromethorphan improving the efficacy of bupropion? Maybe the drug company already knows that this might be popular to abuse and they could cash in on that. I don’t know why I don’t trust these guys. 🤔
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The evidence such as it is actually supports dextrometorphan as the more important component with bupropion there mainly to slow down its metabolism.
 
calvnandhobbs68 said:
Wat? You can walk into any pharmacy in this country and buy a bottle of dextromethorphan. So yeah...neither med component is scheduled which is why it isn't scheduled.

Long-Acting CoughGels

Get lasting cough relief at home or on the go with Robitussin Long-Acting CoughGels. CoughGels control and relieve a frequent cough for up to 8 hours.
www.robitussin.com www.robitussin.com
Click to expand...
DXM is not scheduled but it is actually sales limited because it can be used as raw material for synthesis of MDMA. So you can buy a bottle otc but if you try to buy ten bottles the pharmacy will flag it.

I guess the DEA only bothers to limit things if they seem like they might actually be fun.
 
tr said:
DXM is not scheduled but it is actually sales limited because it can be used as raw material for synthesis of MDMA. So you can buy a bottle otc but if you try to buy ten bottles the pharmacy will flag it.

I guess the DEA only bothers to limit things if they seem like they might actually be fun.
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I’m not sure what the mg of dxm is in this med vs cough syrup but wouldn’t this lend itself to the same thing.
 
Attending1985 said:
I’m not sure what the mg of dxm is in this med vs cough syrup but wouldn’t this lend itself to the same thing.
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Like I mentioned above, 7.5ml of extended release cough syrup is equivalent to a pill of this (45mg DXM). This is also the extended release version of DXM in these pills, so possibly lending itself less to abuse.
 
clausewitz2 said:
The evidence such as it is actually supports dextrometorphan as the more important component with bupropion there mainly to slow down its metabolism.
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This is pulled straight from wikipedia but I thought it was really interesting, because the putative mechanism for DXM is NMDA receptor antagonism:

Dextromethorphan acts as an NMDA receptor antagonist, serotonin–norepinephrine reuptake inhibitor, σ1 receptor agonist, and nicotinic acetylcholine receptor negative allosteric modulator, among other actions, whereas bupropion acts as a norepinephrine–dopamine reuptake inhibitor and nicotinic acetylcholine receptor negative allosteric modulator.[12][7] Dextromethorphan/bupropion has less activity as an NMDA receptor antagonist than dextromethorphan alone.[10] This is because bupropion is a potent CYP2D6 inhibitor and prevents the bioactivation of dextromethorphan into dextrorphan, a much more potent NMDA receptor antagonist than dextromethorphan itself.
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calvnandhobbs68 said:
Like I mentioned above, 7.5ml of extended release cough syrup is equivalent to a pill of this (45mg DXM). This is also the extended release version of DXM in these pills, so possibly lending itself less to abuse.
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Was not aware of this extended release DXM option and had despaired of replicating this med with Wellbutrin and cough syrup, but this might be very workable. And probably less likely to be a fun Saturday night.
 
From my FB feed a few weeks ago...
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I think this med is doomed to fail, but that's a psychiatrist's opinion. I had a friend repping a combination dermatology cream, two generic meds, mixed in 1 tube was like $400, but basically pennies for each cream separately, and apparently dermatologists prescribed it like crazy.
 
I'm sure it will be way too expensive for what it is. I think to some extent it will be dependent on how it is marketed. I don't see myself prescribing it ever though; I hope it is doomed to fail. There are already too many other options for treating psychiatric disorders. Enough just feels like enough.
 
FlowRate said:
Seems like the most legitimate possible reason for these combo meds is adherence. Highly doubtful anyone would fund a study to see if they actually promote adherence, however.
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Not to intrude where I don't belong, but this was actually just (indirectly) published recently in NEJM: https://www.nejm.org/doi/full/10.1056/NEJMoa2208275

Granted, it's in a different patient population, but the authors speculated that the putative mechanism by which this "polypill" works is by increased patient adherence.
 
MonkeyArrow said:
Not to intrude where I don't belong, but this was actually just (indirectly) published recently in NEJM: https://www.nejm.org/doi/full/10.1056/NEJMoa2208275

Granted, it's in a different patient population, but the authors speculated that the putative mechanism by which this "polypill" works is by increased patient adherence.
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Pretty sure "usual care" was also different doses of different drugs.
 
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