Nuedexta and Amyotrophic Lateral Sclerosis

There are a select few medications that have been approved by the FDA for the treatment of ALS. Among these, Rilutek and Radicava are probably the most well known.

Some medications have been approved to treat conditions which are associated with an ALS diagnosis. These include Nuedexta, which is used in the treatment of pseudobulbar affect or PBA.

Here we take a look at this drug and how it can be used to support individuals with ALS, how it works and considerations such as side effects that individuals need to take into account. 

What is Pseudobulbar Affect (PBA)?

Pseudobulbar affect occurs in several different conditions associated with brain function, not just ALS. It’s characterized by sudden uncontrolled laughing or crying that has little to do with what is happening to the individual at any given time.

For example, the affected individual might start laughing when they are sad or crying when they are happy.

It’s a neurological condition and is seen in traumatic brain injury, in people with dementia and following a stroke. As many as 50% of people diagnosed with ALS will experience pseudobulbar affect.

What is Nuedexta and How Does it Work?

The treatment of pseudobulbar affect (PBA) involves giving the individual an oral medication such as Nuedexta. This is a mix of two drugs: dextromethorphan and quinidine.

• Dextromethorphan is more commonly used to suppress coughing for certain air passage infections.
• Quinidine is often used to treat an irregular heartbeat. It’s used here to improve the efficacy of dextromethorphan.

It’s not quite certain how Nuedexta works here but it’s thought that it acts on certain areas of the brain that direct the bulbar muscles around the throat and mouth. These muscles are involved in speech and swallowing.

The drug is taken orally with a full glass of water and the required dose is normally to take one capsule every 12 hours. Because there are some side-effects with Nuedexta, physicians will generally begin with a relatively low dose and monitor the effect, increasing where necessary.

Thing to Consider

While most people won’t exhibit extreme side-effects, Nuedexta is not suitable for everyone. It should not be taken, for example, by anyone who has suffered heart failure or has a condition such as heart rhythm disorder.

Some people also have an allergic reaction to dextromethorphan or quinidine. The drug should not, therefore, be prescribed without taking a full medical history.

There are some side-effects associated with Nuedexta. If someone is allergic to the ingredients they may suffer from symptoms such as shortness of breath, hives, as well as swelling of the lips and throat or tongue.

Other side-effects can include:

• Increased heartbeat or ‘fluttering’
• Dizziness which may cause an individual to pass out
• Nose bleed and bleeding gums
• Individuals may find that they bruise more easily
• There may be some burning sensation or pain when urinating
• Diarrhea, excessive wind and vomiting

Some people will suffer from liver issues when they take Nuedexta over a prolonged period. This might include pain on the right side where the liver is located, vomiting and yellowing of the eyes or skin.

Also, those who take this drug may feel pain in the chest, experience flu-like symptoms and develop a rash that gets worse when exposed to sunlight.

In rare cases, hallucinations, fever and agitation, twitching and loss of coordination may occur. It’s important to contact the person’s physician if this happens as it could indicate serotonin syndrome. While this can be mild, if symptoms are severe it can be threatening to life.

Nuedexta Clinical Trials

Nuedexta has been used in a range of clinical trials to ensure it’s safety and suitability for use in conditions like ALS, in particular for the treatment of pseudobulbar affect (PBA).

• One study published in Neurotherapeutics in 2017 showed that ALS patients had improved swallowing and speech following treatment with Nuedexta.
• Another study in the Annals of Neurology looked at the effect of different doses of the drug on tolerability and efficacy. It found that dextromethorphan with ultra-low dose quinidine reduced PBA in ALS patients and improved their mental wellbeing.
• The long-term safety of Nuedexta has also been investigated which has shown that the drug is well-tolerated in patients that have been diagnosed with ALS and exhibit PBA.

Pseudobulbar affect can be a huge issue for individuals living with ALS and it can have a significant impact on their quality of life and mental wellbeing.

Nuedexta, despite the potential for side-effects for some, currently remains the most effective way to reduce symptoms associated with PBA.