The fast proliferation of a new drug throughout nursing homes in America has generated a significant amount of concern among medical inspectors and loved ones alike. This drug, known as Nuedexta, was initially prescribed to treat patients experiencing episodes of a rare condition known as PseudoBulbar affect (PBA). According to Nuedexta’s webpage, PBA is defined as “a medical condition that causes involuntary, sudden, and frequent episodes of crying and/or laughing in people living with certain neurological conditions or brain injury.” Conditions that are often associated with PBA occurrences include multiple sclerosis, Alzheimer’s disease and dementia, traumatic brain injuries, Parkinson’s disease, and, most commonly, Lou Gehrig’s disease.
According to CNN, the drug’s sales have surged upon their increasing popularity among nursing homes, which often prescribe Nuedexta to patients with dementia. Sales of Nuedexta totaled $300 million in 2016 alone; despite the increase in prescriptions of Nuedexta over the course of the previous five years, the drug manufacturer, Avanir, has admitted to the lack of clinical trials focusing specifically on elderly people with dementia. Meanwhile, the FDA has approved the use of the drug for the treatment of anyone exhibiting symptoms similar to those of PBA. This, however, has resulted in ambiguity in the interpretations of dementia related symptoms that may or may not be related to PBA. In addition, within the past 3 years, several doctors with direct ties to Avanir have found themselves in legal trouble for wrongly prescribing Nuedexta to patients and receiving monetary “kickbacks” from Avanir in return.
Nuedexta is administered orally as a pill containing 20mg of dextromethorphan HBr and 10 mg quinidine sulfate. Dextromethorphan is also an active ingredient in OTC cough suppressants such as Robitussin and Nyquill.
(dextromethorphan - image from Wikipedia)
(As a side note, I found a bottle of Children’s Dimetapp cough syrup at home, and it contains 2mg of dedtromethorphan HBr per dose, as well as a couple of other active ingredients).
Dextromethorphan is also a known serotonin reuptake inhibitor, which increases extracellular serotonin concentrations and blocks the action of the serotonin transporter. It is also a sigma-1 receptor agonist, meaning it interferes with the receptor’s ability to regulate calcium signaling within the cell membrane. (Sigma-1 receptor activity is involved in signaling that leads to cocaine abuse, as well as schizophrenia and depression.)
Meanwhile, the other active ingredient, quinidine sulfate, is a class I antiarrhythmic agent, meaning it modifies sodium channel activity in ways that stabilize arrhythmic heartbeats.
While this drug may be an adequate treatment for patients known to have PBA, the overarching prescriptions of Nuedexta, as well as the apparent corruption in those prescribing it, do not reflect well on the drug. Only clinical trials on those with dementia will serve to adequately determine whether the drug is an effective treatment for those with the disorder.
References:
https://www.nuedexta.com
https://en.m.wikipedia.org/wiki/Sigma-1_receptor
http://www.cnn.com/2017/10/12/health/nuedexta-nursing-homes-invs/index.html
https://en.m.wikipedia.org/wiki/Dextromethorphan
https://en.m.wikipedia.org/wiki/Quinidine
https://en.m.wikipedia.org/wiki/Antiarrhythmic_agent#Class_I_agents
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