Nuedexta, PCP in Disguise

Nuedexta (dextromethorphan hydrobromide and quinidine sulfate) marketed by Avanir Pharmaceuticals is FDA approved for the treatment of PseudoBulbar Affect (PBA), a so-called neurological condition thought to cause involuntary, sudden, and frequent episodes of crying and/or laughing, observed with patients having amyotrophic lateral sclerosis (ALS), multiple sclerosis (MS), strokes, or traumatic brain injury. It was originally approved in 2010 by the FDA for such emotional instability.

Dextromethorphan may cause serotonin syndrome, a buildup of an excessive amount of serotonin in the body, and this risk is increased by overdose, particularly if taken with other serotonergic agents, SSRIs or tricyclic antidepressants.

Side effects of serotonin syndrome can be altered mental status, muscle twitching, confusion, high blood pressure, fever, restlessness, sweating, tremors, or shivering. Use of Nuedexta with selective serotonin reuptake inhibitors (SSRIs) or tricyclic antidepressants increases the risk of these side effects.

These are not all the possible side effects.

The quinidine in the formula is used to suppress metabolism of the dextromethorphan in order to increase the bioavailability of the dextromethorphan, and is not part of the treatment for PBA. Dextromethorphan acts on the central nervous system, but the mechanism by which dextromethorphan exerts any therapeutic effects in patients with PBA is totally unknown — it’s just a guess from clinical observations that it might have such a symptomatic effect.

Dextromethorphan, derived from an opioid analgesic, is sometimes referred to as DXM or the poor man’s PCP (phencyclidine, or Angel Dust), and is also used recreationally — acting as a dissociative anesthetic producing hallucinogenic states, delusions, or paranoia. At high concentrations, DXM can result in a false-positive for PCP on a drug screen. It is a nonselective serotonin reuptake inhibitor. Its previous primary use since 1958 is as a cough suppressant. Regular use over a long period of time can cause withdrawal symptoms. DXM is often used as a substitute for marijuana, amphetamine, and heroin by drug abusers, and its use as an antitussive (cough suppressant) is now known to be less beneficial than originally thought.

We think that part of the danger of this drug is that it can be prescribed for various symptoms in the Diagnostic and Statistical Manual of Mental Disorders (DSM) just because of its claims of symptomatic relief — in spite of the fact that its mechanism of operation is unknown, its use can be severely abused, and its side effects can be fatal; and the symptoms of its side effects as well as the original medical issues can lead to the prescription of other dangerous and addictive psychiatric drugs.

Examples of DSM diagnoses that may be involved are “Histrionic personality disorder”, “High expressed emotion level within family”, “Adjustment disorder, With mixed disturbance of emotions and conduct”, and “Unspecified mental disorder due to another medical condition”.

Nuedexta is not thought of or advertised as a psychotropic drug, but exposing its camouflage one can now see that essentially it is psychoactive and should be avoided — another example of a psychiatric drug disguised as a legitimate medical drug.

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