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ALSUntangled #71: Nuedexta.

Yuyao Sun1, Michael Benatar2, Javier Mascías Cadavid3

  • 1Neurology Department, University of Kentucky, Lexington, KY, USA.

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Summary
This summary is machine-generated.

Nuedexta (dextromethorphan hydrobromide and quinidine sulfate) may improve bulbar function in people with ALS, even without pseudobulbar affect (PBA). Clinical trials suggest benefits for ALS bulbar dysfunction with manageable side effects.

Keywords:
ALSN-Methyl-D-Aspartate receptor (NMDAR)Nuedextadextromethorphansigma-1 receptor (S1R)

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Area of Science:

  • Neurology
  • Pharmacology

Background:

  • Pseudobulbar affect (PBA) is a neurological disorder characterized by involuntary emotional expression.
  • Nuedexta, a combination of dextromethorphan hydrobromide and quinidine sulfate, is FDA-approved for PBA.
  • Anecdotal reports suggest Nuedexta may benefit bulbar function in ALS patients.

Approach:

  • Review of off-label Nuedexta use for bulbar function in Amyotrophic Lateral Sclerosis (ALS).
  • Examination of Nuedexta's proposed neuroprotective mechanisms, including effects on Sigma-1 receptor (S1R) and glutamate excitotoxicity.
  • Analysis of recent clinical trial data supporting Nuedexta's efficacy in PALS.

Key Points:

  • Nuedexta has plausible mechanisms for protecting brain stem motor neurons.
  • Recent clinical trials indicate Nuedexta can improve bulbar function in people with ALS (PALS), irrespective of PBA.
  • Nuedexta treatment is associated with mild to moderate side effects.

Conclusions:

  • Nuedexta shows promise for improving bulbar dysfunction in ALS patients.
  • Consideration of Nuedexta for ALS patients with bulbar symptoms, with or without PBA, is supported.
  • Further research may elucidate optimal use and long-term outcomes of Nuedexta in ALS.