ALSUntangled #71: Nuedexta

Nuedexta is a combination of dextromethorphan hydrobromide and quinidine sulfate and was approved by the Food and Drug Administration (FDA) in 2010 to treat pseudobulbar affect (PBA). There have since been anecdotal case reports of bulbar function improvements after Nuedexta treatment. Here, we review the off-label use of Nuedexta for improving bulbar function in people with ALS. Nuedexta has plausible mechanisms for protecting brain stem motor neurons via its effects on S1R and glutamate excitotoxicity. Recent clinical trials support that Nuedexta can improve bulbar function in PALS, with or without PBA. Nuedexta causes mild to moderate side effects. Based on this information, we support considering Nuedexta treatment for bulbar dysfunction in ALS patients with or without PBA.

Automated summary

Nuedexta, a combination of dextromethorphan hydrobromide and quinidine sulfate, was approved by FDA in 2010 for treating PBA. There are anecdotal case reports of improved bulbar function after Nuedexta treatment in ALS patients. Recent clinical trials support that Nuedexta can improve bulbar function in PALS, with or without PBA. It causes mild to moderate side effects. Considering Nuedexta treatment for bulbar dysfunction in ALS patients with or without PBA is supported based on this information.