Combo Rx Quelled Alzheimer's Agitation

Dextromethorphan-quinidine combination may reduce Alzheimer's disease agitation, aggression

/ Author:  / Reviewed by: Joseph V. Madia, MD

(RxWiki News) Relief for one of the worst symptoms of Alzheimer's disease may soon be on the way.

A new study found that a combination of the drugs dextromethorphan and quinidine may reduce agitation and aggression in patients with Alzheimer's disease (AD). The combo drug is marketed under the name Nuedexta.

Dextromethorphan (brand name Delsym) is an over-the-counter cough suppressant. Quinidine is a prescription drug typically used to treat irregular heartbeat (arrhythmia) and malaria.

"We concluded on the basis of this study that dextromethorphan and quinidine are effective in reducing agitation in patients with Alzheimer's disease," said lead study author Jeffrey L. Cummings, MD, ScD, director of the Cleveland Clinic Lou Ruvo Center for Brain Health, in a press release. "The drug was both safe, from a cardiac and systemic point of view, and well tolerated by the patients."

Dementia is a general term for a decline in mental ability severe enough to interfere with daily life. AD is the most common form of dementia.

Agitation and aggression are common symptoms of dementia. Both can significantly reduce patient well-being and increase caregiver stress.

Nuedexta is approved for the treatment of pseudobulbar affect, a neurological disorder marked by uncontrollable outbursts of crying or laughing.

For this study, Dr. Cummings and team looked at Nuedexta's potential effects on 220 AD patients with substantial agitation over the span of two five-week periods.

During the first five weeks, patients were given either Nuedexta or a placebo. During the second, some patients on the placebo were switched to Nuedexta.

At the end of the 10 weeks, 55 percent of these patients showed 50 percent less agitation. About 65 percent showed 30 percent less agitation.

Dr. Cummings and team also measured the stress levels of each patient's caregivers. Caregivers whose patients were given Nuedexta reported less stress than those whose patients were given the placebo.

In an editorial about this study, Anne Corbett, PhD, a neuroscience expert at Wolfson Centre for Age-Related Diseases at King’s College London, wrote, "There is a reasonably strong case to prioritize dextromethorphan-quinidine as an off-label treatment for agitation, possibly as a safer alternative to atypical anti-psychotics."

This study was published Sept. 22 in the journal JAMA.

Avanir Pharmaceuticals (maker of Nuedexta) funded this research. Several study authors disclosed ties to pharmaceutical companies, such as Avanir.

Reviewed by: 
Review Date: 
September 22, 2015
Last Updated:
September 22, 2015