get rid of [30:10%: Gastrointestinal: Diarrhea (13%) 1% to 10%: Cardiovascular: Peripheral edema (5%) Central nervous system: Dizziness (10%) Endocrine & metabolic: Increased gamma-glutamyl transferase (3%) Gastrointestinal: Vomiting (5%), flatulence (3%) Genitourinary: Urinary tract infection (4%) Infection: Influenza (4%) Neuromuscular & skeletal: Weakness (5%) Respiratory: Cough (5%) Warnings/Precautions Concerns related to adverse effects: Anticholinergic effects: May cause anticholinergic effects; use caution in patients with myasthenia gravis or other conditions which may be affected. Dizziness: May cause dizziness; use caution in patients with motor impairment or history of falls. Hepatotoxicity: Quinidine has been associated with hepatitis, including granulomatous hepatitis, occurring generally during the first few weeks of therapy. Most cases resolve when quinidine is discontinued. Hypersensitivity reactions: Agranulocytosis, angioedema, bronchospasm, hemolytic anemia, increased skeletal muscle enzymes, lymphadenopathy, myalgia, pneumonitis, rash, sicca syndrome, uveitis, vasculitis may be associated with use. Lupus-like syndrome: Lupus-like syndrome, with polyarthritis and sometimes a positive antinuclear antibody test, may occur with quinidine. Use is contraindicated in patients with quinidine-, quinine-, or mefloquine-induced lupus-like syndrome. Thrombocytopenia: Immune-mediated thrombocytopenia (severe or fatal) may be associated with quinidine use. Unless clearly not drug related, discontinue immediately; continued use may be associated with an increase in fatal hemorrhage. Thrombocytopenia generally resolves within a few days of discontinuation. Therapy should not be restarted in sensitized patients. Use is contraindicated in patients with prior history of immune-mediated thrombocytopenia associated with structurally related drugs (eg, quinine, mefloquine). Concurrent drug therapy issues: High potential for interactions: Concomitant use of moderate or strong CYP3A4 inhibitors may increase quinidine levels and prolong the QTc interval. Quinidine inhibits CYP2D6; concomitant use with CYP2D6 substrates may cause an accumulation of concomitantly administered drug and/or reduce active metabolite formation, decreasing their safety and/or efficacy. QT prolonging agents: Use caution with medications which may further prolong the QT interval or cause cardiac arrhythmias. Dose-dependent QTc prolongation may occur. Monitor patients at risk following the first dose. Discontinue if arrhythmia occurs. Serotonin syndrome: Symptoms associated with serotonin syndrome such as agitation, confusion, hallucinations, hyper-reflexia, myoclonus, shivering, and tachycardia may occur with concomitant proserotonergic drugs (ie, SSRIs/SNRIs or triptans); especially with higher dextromethorphan doses. Discontinue if such reaction occurs. Disease-related concerns: Cardiovascular disease: Use caution in patients with left ventricular hypertrophy or left ventricular dysfunction which are more common in patients with chronic hypertension, coronary artery disease or history of stroke; risk of QTc prolongation may be increased. Use is contraindicated in patients with prolonged QT interval, congenital QT syndrome, or history of torsade de pointes, patients with heart failure, complete AV block without an implanted pacemaker or patients at high risk of complete AV block. Correct hypokalemia or hypomagnesemia prior to therapy. Hepatic impairment: Safety and efficacy have not been established with severe hepatic impairment; increased serum concentrations may occur. Renal impairment: Safety and efficacy have not been established with severe renal impairment; increased serum concentrations may occur. Special populations: CYP2D6 poor metabolizers: Dextromethorphan is metabolized by hepatic CYP2D6. Poor metabolizers of CYP2D6 may have exaggerated or prolonged effects of dextromethorphan. Increased risk may be seen with concomitant use of potent CYP2D6 inhibitors; use with caution (Abduljalil 2010; Jurica 2012; Sager 2014; Zhou 2009). Dementia: Has not shown to be safe or effective in other types of commonly occurring emotional labilities (eg, neurological disease or injury). Other warnings/precautions: Appropriate use: Periodically reassess the need for treatment; spontaneous improvement of PBA may occur. Abuse/misuse: Patients with a history of drug abuse should be monitored closely for signs of abuse/misuse (eg, development of tolerance, increase in dose, drug-seeking behavior). Abuse of dextromethorphan may cause brain damage, cardiac arrhythmia, loss of consciousness, or death. Monitoring Parameters QT interval at baseline and 3 to 4 hours after the first dose in patients at risk for QT c prolongation; potassium and magnesium prior to and during therapy; CBC, liver and renal function tests; periodically assess risk factors for arrhythmias during treatment; periodically reassess the need for treatment (spontaneous improvement of PBA may occur); worsening myasthenia gravis or other sensitive conditions due to anticholinergic effects. Pregnancy Risk Factor C Pregnancy Considerations Adverse events were observed in animal reproduction studies using this combination. See individual agents. Patient Education Discuss specific use of drug and side effects with patient as it relates to treatment. (HCAHPS: During this hospital stay, were you given any medicine that you had not taken before? Before giving you any new medicine, how often did hospital staff tell you what the medicine was for? How often did hospital staff describe possible side effects in a way you could understand?) Patient may experience diarrhea or cough. Have patient report immediately to prescriber signs of bleeding (vomiting blood or vomit that looks like coffee grounds; coughing up blood; hematuria; black, red, or tarry stools; bleeding from the gums; abnormal vaginal bleeding; bruises without a reason or that get bigger; or any severe or persistent bleeding); signs of lupus (rash on the cheeks or other body parts, sunburn easy, muscle or joint pain, angina or shortness of breath, or swelling in the arms or legs); signs of liver problems (dark urine, fatigue, lack of appetite, nausea, abdominal pain, light-colored stools, vomiting, or jaundice), abnormal heartbeat, severe dizziness, tachycardia, passing out, severe loss of strength and energy, severe nausea, severe vomiting, chills, enlarged lymph nodes, swelling of arms or legs, depression, vision changes, or signs of serotonin syndrome (dizziness, severe headache, agitation, hallucinations, tachycardia, abnormal heartbeat, flushing, tremors, sweating a lot, change in balance, severe nausea, or severe diarrhea) (HCAHPS). Educate patient about signs of a significant reaction (eg, wheezing; chest tightness; fever; itching; bad cough; blue skin color; seizures; or swelling of face, lips, tongue, or throat). Note: This is not a comprehensive list of all side effects. Patient should consult prescriber for additional questions. Intended Use and Disclaimer: Should not be printed and given to patients. This information is intended to serve as a concise initial reference for healthcare professionals to use when discussing medications with a patient. You must ultimately rely on your own discretion, experience and judgment in diagnosing, treating and advising patients. Next Interactions Print this page Add to My Med List More about dextromethorphan/quinidine Side Effects During Pregnancy Dosage Information Drug Interactions Support Group En Español 13 Reviews Add your own review/rating Drug class: miscellaneous central nervous system agents Consumer resources Dextromethorphan and quinidine Dextromethorphan and quinidine (Advanced Reading) Professional resources Dextromethorphan Hydrobromide and Quinidine Sulfate (AHFS Monograph) Other brands: Nuedexta Related treatment guides Pseudobulbar Affect] Drug Status Rx Availability Prescription only C Pregnancy Category Risk cannot be ruled out N/A CSA Schedule Not a controlled drug Approval History Drug history at FDA Dextromethorphan / quinidine Rating 13 User Reviews 8.2 /10 13 User Reviews 8.2 Rate it! Drug Class Miscellaneous central nervous system agents Related Drugs miscellaneous central nervous system agents Namenda , memantine , Ampyra , Nuedexta , Namenda XR , riluzole Pseudobulbar Affect Nuedexta , dextromethorphan / quinidine , More... you should be
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