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Overview: Nuedexta is used to treat a condition called pseudobulbar affect, which is where you sometimes cry, laugh, or get angry unexpectedly. The combination of dextromethorphan and quinidine in this medicine helps to lower the number of sudden, uncontrolled reactions. The most common side effects include dizziness, tiredness, and diarrhea. Before taking Nuedexta, make sure to tell your healthcare provider about any medicines you are taking.

Uses

What is Nuedexta used for?

Nuedexta (dextromethorphan/quinidine) is commonly used to treat people with pseudobulbar affect, a condition that can make you laugh, cry, or become angry without being able to control when it happens.  

Nuedexta may also be used for other conditions as determined by your healthcare provider.

How does Nuedexta work (mechanism of action)?

Nuedexta is thought to help modify brain signals that affect mood and emotions and help reduce the number of sudden, uncontrolled reactions that happen with pseudobulbar affect. 

How is Nuedexta supplied (dosage forms)?

Brands and other names

  • Nuedexta

Dosage forms and strengths

  • 20 mg/10 mg oral capsules

How should I store Nuedexta?

Nuedexta should be stored at room temperature, between 68 F to 77 F (20 C to 25 C). It can be exposed to temperatures between 59 F to 86 F (15 C to 30 C) for shorter periods of time, such as when transporting it. Store in a cool, dry place. 

Side Effects

What are the most common side effects of Nuedexta?

The most common side effects of Nuedexta are listed below. Tell your healthcare provider if you have any of these side effects that bother you.

  • Diarrhea
  • Dizziness
  • Cough
  • Vomiting
  • Feeling unusually weak or tired
  • Fluid retention
  • Urinary tract infection
  • Flu-like symptoms
  • Gas

There may be other side effects of Nuedexta that are not listed here. Contact your healthcare provider if you think you are having a side effect of a medicine. In the U.S., you can report side effects to the FDA at www.fda.gov/medwatch or by calling 800-FDA-1088. In Canada, you can report side effects to Health Canada at www.health.gc.ca/medeffect or by calling 866-234-2345.

What are the serious side effects of Nuedexta?

While less common, the most serious side effects of Nuedexta are described below, along with what to do if they happen.

Severely Low Platelet Levels. Nuedexta can cause you to have a severely low number of platelets in your blood, also called thrombocytopenia. Platelets help to form blood clots. Having a low level of platelets may increase your risk of bleeding. Tell your healthcare provider if you have any of the following symptoms of low platelet levels.

  • Easy bruising or bleeding
  • Bleeding that does not stop
  • Nosebleeds

Immune System Reactions. Nuedexta can cause inflammation of your liver, blood vessels, or lymph vessels and cause symptoms that look like a condition called lupus. Stop taking Nuedexta and call your healthcare provider right away if you develop any of the following symptoms.

  • Rash
  • Joint pain
  • Fever
  • Weakness or unusual tiredness

Liver Damage. Liver damage, also called hepatotoxicity, can happen when taking Nuedexta. Call your healthcare provider right away if you have any of the following symptoms of liver damage.

  • Nausea or vomiting
  • Stomach or belly pain
  • Fever
  • Weakness or unusual tiredness
  • Itching
  • Loss of appetite
  • Light-colored poop
  • Dark-colored urine (pee)
  • Your skin or the whites of your eyes turning yellowish in color (also called jaundice)

Heart Rhythm Changes. Nuedexta may cause a rare, dangerous heart rhythm problem called QT prolongation and torsade de pointes. Some people have a higher risk of this, including people who are older, have other people in their family who have had these conditions, have low potassium or magnesium levels, or who take medicines that can prolong the QT interval. Tell your healthcare provider right away if you faint or have changes in your heart rate or rhythm, such as a fast or skipping heartbeat.

Dizziness. Nuedexta can make you dizzy. Do not drive or do other activities that require alertness or coordination until you know how Nuedexta affects you.

Severe Allergic Reactions. Nuedexta may cause allergic reactions, which can be serious. Stop taking Nuedexta and get help right away if you have any of the following symptoms of a serious allergic reaction.

  • Breathing problems or wheezing
  • Racing heart
  • Fever or general ill feeling
  • Swollen lymph nodes
  • Swelling of the face, lips, mouth, tongue, or throat
  • Trouble swallowing or throat tightness
  • Itching, skin rash, or pale red bumps on the skin called hives
  • Nausea or vomiting
  • Dizziness, feeling lightheaded, or fainting
  • Stomach cramps
  • Joint pain

Warnings & Precautions

Who should not use Nuedexta?

Allergies to Ingredients. People who are allergic to any of the following should not take Nuedexta.

  • Nuedexta
  • Dextromethorphan
  • Quinidine
  • Any of the ingredients in the specific product dispensed

Your pharmacist can tell you all of the ingredients in Nuedexta.

Drug Interactions. Nuedexta should not be taken while you are using certain other medicines. Before taking Nuedexta, tell your healthcare provider about any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and other supplements you are using. See the Interactions section for more details.

Previous Hypersensitivity Reaction. People who have developed severely low platelet levels, liver damage, bone marrow problems or symptoms that look like a condition called lupus from taking Nuedexta, quinidine, or medicines called quinine or mefloquine should not take Nuedexta.

Prolonged QT Interval. Nuedexta should not be used by people with a prolonged QT interval, including congenital long QT syndrome. People with a history of QT prolongation should also not use Nuedexta. 

Heart Failure. Nuedexta should not be used by people with heart failure. 

Heart Block. People with or at risk of complete heart block, also called atrioventricular (AV) block, should not use Nuedexta unless they have a pacemaker.

What should I know about Nuedexta before using it?

Do not take Nuedexta unless it has been prescribed to you by a healthcare provider. Take it as prescribed.

Take each dose of Nuedexta approximately 12 hours apart. 

Do not share Nuedexta with other people, even if they have the same condition as you. It may harm them.

Keep Nuedexta out of the reach of children.

Nuedexta can affect your alertness or coordination. Do not drive or do other activities that require alertness or coordination until you know how Nuedexta affects you.

Your healthcare provider may check your heart rhythm before starting this medicine and recheck it after the first dose. This is to help monitor for any dangerous changes in heart rhythm. 

Your healthcare provider will likely perform blood work before starting this medicine and routinely while you are taking it. This is to check on your electrolyte levels and help monitor your risk for dangerous heart rhythms. Keep all appointments for blood work.

What should I tell my healthcare provider before using Nuedexta?

Tell your healthcare provider about all of your health conditions and any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and other supplements you are using. This will help them determine if Nuedexta is right for you.

In particular, make sure that you discuss any of the following.

Other Current and Past Health Conditions. Tell your healthcare provider if you have any of the following.

  • Blood disorders
  • Liver problems
  • Kidney problems
  • Abnormal heart rate or rhythm 
  • Lupus
  • Heart disease, including heart failure
  • Problems metabolizing medicine
  • Electrolyte imbalance
  • Myasthenia gravis

Pregnancy. It is not known if or how Nuedexta could affect pregnancy or harm an unborn baby. Tell your healthcare provider if you are or plan to become pregnant.

Breastfeeding. Nuedexta passes into breast milk. Tell your healthcare provider if you are breastfeeding or plan to breastfeed. Your healthcare provider will advise you if you should take Nuedexta while breastfeeding.

How can I get more information about Nuedexta?

For more information about Nuedexta, you can visit the manufacturer’s website at www.nuedexta.com or call them at 855-468-3339.

Interactions

Does Nuedexta interact with foods or drinks?

Drinking grapefruit juice while taking Nuedexta can increase the risk for serious side effects. It is best to limit or avoid drinking grapefruit juice while taking this medicine. 

It is unknown if drinking alcohol will affect Nuedexta. The risk of dizziness, drowsiness, and liver damage may be increased if you drink alcohol while taking this medicine. It is best to limit the amount of alcohol you drink while taking Nuedexta.

Does Nuedexta interact with other medicines (drug interactions)?

Always tell your healthcare provider about any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and other supplements you are using.

In particular, make sure that you discuss if you are using any of the following before using Nuedexta.

  • A monoamine oxidase inhibitor (MAOI) within the past 2 weeks, which is a medicine usually used for depression or Parkinson’s disease
  • A medicine for malaria, such as mefloquine or quinine
  • Quinidine, which is a medicine used for abnormal heart rhythm or to treat malaria
  • Medicines that can cause QT prolongation, which is a potentially dangerous heart rhythm problem, such as erythromycin, clarithromycin, fluconazole, thioridazine, and pimozide
  • An antipsychotic, which is a medicine for certain mental health conditions
  • A selective serotonin reuptake inhibitor (SSRI), such as fluoxetine, paroxetine, or sertraline, which is a medicine commonly used for anxiety and depression
  • A tricyclic antidepressant, such as amitriptyline, nortriptyline, or protriptyline, even if it is not used for depression
  • Digoxin (Lanoxin), which is a medicine used to treat irregular heartbeat and some types of heart failure

Many other medicines may alter the blood levels of Nuedexta. Tell your healthcare provider about all medicines that you take or have recently taken.

This may not be a complete list of medicines that can interact with Nuedexta. Always check with your healthcare provider.

Does interact with other drugs you are taking?

Enter your medication into the WebMD interaction checker

Overdose/Missed Dose

What should I do if I accidentally use too much Nuedexta?

If you or someone else has used too much Nuedexta, get medical help right away, call 911, or contact a Poison Control center at 800-222-1222.

What should I do if I miss a dose of Nuedexta?

If you miss a dose, take it as soon as you remember. If it is almost time for your next dose, skip the missed dose and only take the next dose. Do not take double or extra doses.