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ALS Worldwide welcomes any questions or comments you might have.  We provide free, personalized and confidential support services to anyone in the ALS community—whether you are a patient or a loved one, friend, health care professional or caregiver of someone diagnosed.

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ALS Worldwide
5808 Dawley Drive
Fitchburg, WI 53711‑7209

ALS Worldwide
January 12, 2016

Nuedexta - Improving Quality of Life for ALS/MND Patients

An Important Update from the 26th International Symposium on ALS/MND

A very important aspect of this symposium was the official recognition that Nuedexta has a beneficial effect on all bulbar symptoms in addition to pseudobulbar affect, (uncontrollable laughter and crying) something we have realized anecdotally through our work with patients for many years. Many neurologists are now in agreement with ALS Worldwide that Nuedexta prescriptions for those that have difficulty eating, swallowing, speaking and breathing will probably provide benefit to those patients. Results from the NEALS (Northeast ALS Association) trial, begun in 2013 and concluded in 2015, verify these anecdotal observations. Discuss Nuedexta, or its generic equivalent, with a neurologist, pulmonologist or primary care physician to obtain a prescription. In more than seven years of usage we have observed these additional benefits; easier, more effective chewing and swallowing; better control of saliva and expectoration; better use of facial, tongue and lip muscles; improved speech; respiratory benefit. If you or your physician would like to discuss Nuedexta further, contact ALS Worldwide via telephone - 608-663-0920 or email [email protected].

Background Information

PBA can occur when areas of the brain that normally control expressions of emotion are disturbed. Brain signaling is interrupted, causing a “short circuit." Although PBA symptoms can feel like depression, PBA is a separate, neurological condition and should not be treated with traditional anti-depressants.

Nuedexta is the first and only prescription medication to receive FDA approval to treat PBA in ALS patients. Developed by Dr. Richard A. Smith, a neurologist with the Center for Neurologic Study in San Diego, CA. Nuedexta is manufactured by Avanir Pharmaceuticals. A compounded form, dextromethorphan, can also be available through a compounding pharmacy such as Hopewell Pharmacy in Hopewell New Jersey. It has been shown to improve PBA in those with ALS and may also improve other bulbar symptoms. 

Nuedexta contains two components: dextromethorphan hybromide (20 mg), the ingredient active in the central nervous system, and quinidine sulfate (10 mg), a metabolic inhibitor that enables therapeutic dextromethorphan concentrations.

Nuedexta acts on sigma-1 and NMDA receptors in the brain. While Nuedexta is thought to act on areas of the brain responsible for emotional responses, the mechanism by which it is effective in patients with PBA is unknown. Nuedexta’s potential side effects include diarrhea, dizziness, and weakness.

For many years, ALS Worldwide and many neurologists have supported the use of dextromethorphan and quinidine for its positive impact on PBA pseudobulbar affect that so often affects those with ALS/MND. Then, Nuedexta became available from Avanir Pharmaceuticals and the generic (unbranded) version has long been available from compounding pharmacies. What was not so well known, are the other important potential benefits of this remarkable drug that are now acknowledged..