Nuedexta


Nuedexta is a newly approved drug for pseudobulbar affect (PBA). Pseudobulbar affect occurs when certain neurologic diseases damage the area of the brain that controls emotion such as Multiple Sclerosis, Parkinson’s Disease, or stroke. Patients with PBA have sudden outbursts of involuntary, and often inappropriate, laughing or crying. This drug is not proven to be safe for dementia or Alzheimer’s disease. An improvement in behavior may be seen as early as one week. When a patient first begins Nuedexta, they will receive one capsule every morning for 7 days.

Starting on day eight, the patient will receive one capsule in the morning and one capsule in the evening, which should be separated by 12 hours in order to avoid an overdose. No dose adjustments are necessary for mild to moderate renal or hepatic impairment. Nuedexta has not been studied in
patients with severe renal or hepatic impairment, but is thought to be associated with a higher number of adverse reactions. Nuedexta is contraindicated in patients with an AV block, HF, MAO-I therapy, QT prolongation, and torsade de pointe.

Nuedexta’s most common side effects are diarrhea (13%), vomiting (5%), peripheral edema (5%), dizziness (10%), UTI (4%), neuromuscular and skeletal weakness (5%), and cough (4%). Nuedexta is also associated with agranulocytosis, thrombocytopenia, serotonin syndrome, and QT prolongation. Patients should receive baseline potassium and magnesium, CBC, liver and renal function tests, and a QT interval. These tests should also be conducted periodically during treatment.

Recap:

  • Nuedexta is approved to treat pseudobulbar affect.
  • Week 1: 1 capsule every morning.
  • Week 2: 1 capsule in the morning and one capsule at night approximately 12 hours later.
  • Dosing for renal and hepatic failure has not been established at this time.
  • Nuedexta’s common side effects include diarrhea, vomiting, peripheral edema, dizziness, UTI, neuromuscular and skeletal weakness, and cough.

Sources:
Lexi-Comp Web site. http://0-online.lexi.com.polar.onu.edu/crlsql/servlet/crlonline. Accessed January 6, 2012.
Clinical Pharmacology Web site: http://0-www.clinicalpharmacology-ip.com.polar.onu.edu/Forms/Monograph/monograph.aspx?cpnum=3710&sec=monmp. Accessed January 6, 2012
“Full Prescribing Information for Nuedexta.” Nuedexta. Avanir Pharmaceuticals. 2012. http://www.nuedexta.com. Accessed January 6, 2012.



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