dextromethorphan-quinidine for dementia related agitation

[theduderino]

Do any of you have experience using this? There's a RCT published in JAMA in 2015 around agitation related to alzheimer's that shows a reasonable effect size around reduction in the agitation subscore of the neuropsychiatric inventory scale (effect size of -0.5 to -0.3 depending on the study phase). There is a previous thread that discusses this med when it was first released for pseudobulbar affect - it seems that w/o quinidine on board (a potent 2d6 inhibitor) dextromethorphane doesn't seem to do much. This is problematic b/c the brand drug (nudexta) is horrendously expensive (around 1500 on goodrx)

I would be esp interested if anyone has experience trying to combine dextromethorphan w/ another potent 2d6 inhibitor (e.g prozac).

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[SourceOfDenial]

Why not just use quinidine? Seems odd to go for Prozac here.

Used a few times for agitation and not a lot of sense if it did what I hoped it would. Either in nudexta form or compounded by pharmacy for hospice patients. If symptoms fit a pseudobulbar Like pattern it’s worth a shot, but remains a Hail Mary for me.

 

[clausewitz2]

A Phase III trial for nudexta for agitation in Alzheimer's announced a swing and a miss in September. So not promising.

If I had to guess as why people use the offbrand Prozac combo with DMT, it's that psychiatrists don't know what quinidine is and/or feel uncomfortable prescribing anti-arrhythmics.

 

[aim-agm]

Reach out to a compounding pharmacist and see if they’ll prepare quinidine in 10 mg doses...or just give the patient a grapefruit

 

[SourceOfDenial]

To those that use quinidine, at what dosage are you using and having success. The quinidine sulfate looks to come in 200mg tabs so if you cut that in half it’s still well above the nuedexta dose particularly if doing BID dosing . I love prescribing separate generics over a brand name combo pill of said generics, just wonder how doable it is with this combination

Most pharmacies can get you 10mg/mL liquid.

 

[nexus73]

I’ve had no luck with it for dementia and behavioral disturbance