NUDEXTA- prescription DXM for "PBA"- WTF?

[oar9fi]

So I saw a commercial about a condition called "pseudobulbar affect" which is a conditon charachterized by sudden involuntery bouts of crying or laughter seen in patients who have brain injuries due to stroke, trauma etc. When I saw the commercials were funded by Avanir Pharmaceuticals I was curious as to what new drug they had created for this strange condition.

It turns out it's a mixture of 20mg dextromethorphan hydrobromide & quinidine sulfate 10mg. According to the prescribing info, "The quinidine component of NUEDEXTA is intended to inhibit CYP2D6 so that higher exposure to dextromethorphan can be achieved compared to when dextromethorphan is given alone" (not to mention so they can patent an OTC med & sell it for beaucoup bucks!)

In fact, looking at the products in development by Avanir Pharmaceuticals, two of their other products (still in clinical trials) are "AVP-923" which is also DXM/quinidine & "Deuterated Dextromethorphan."

I just looked up the cost per month for Nuedexta & it's over <snip> a month for 60 20mg/10mg tablets. What?!

Before you know it,I bet Avanir will be lobbying to get DXM banned as an OTC med. This is how America's phama biz works...

https://www.avanir.com/nuedexta

https://www.nuedexta.com/pdf/Prescribing Information.pdf (Prescribing information)

 

[Jabberwocky]

Wow this is some weird shit if you ask me. I've never heard of that condition though I'm sure it may exist in stroke patients. As to how DXM would prevent this from happening is beyond me though - perhaps it's disassociate properties would do it. What scares me is that it's mixed with the quinidine. Frankly it's irresponsible on behalf of the pharma company as it will lead to many more incidents of overdose in patients, and an overdose of DXM is not fun in the slightest possible way.

There's no way that they will be able to patent DXM considering its therapeutic potential for coughs and colds. Although it has potential for abuse, it's considerably less than its predecessor - codeine. This being said, pholcodin appears to be phasing out old cough medicines in the UK and being used as first of line treatment. It's also been around since 1954 so there's no way they could find a way to re-patent the drug, perhaps the combination, but not singularly.

As for the effective ban on the drug - I doubt that would happen as DXM is used as an anti-tissutive drug. Not as one for stopping people laughing and crying. Even if they did manage to get a blanket ban on the stuff it would still be prescribed for coughs. And then begs the question - what replaces OTC cough medications? Glycerin? Liquid sugar? I don't think so. Big pharma already makes a shit ton of money out of selling robocaps and syrups. No way would they stop the sale of it.

 

[oar9fi]

Yeah, it seems like they're kind of shooting themselves in the foot by adding the 2D6 inhibitor since it would greatly increase the chances for interaction with other medications. Most people who have conditions that cause PBA (ALS, MS, Alzheimer's, Parkinson's etc.) are going to be taking several other medications. A small tweak on the DXM molecule would probably have been better suited (but maybe harder to get approved due to being opioid related)

DXM polystirex would actually be a good candidate (or any other time release formula.) I don't think the folks at Avanir thought this one out too well. It seems like alot of companies are more interested in selling stocks to investors than selling medicine to patients.

 

[Jabberwocky]

Well, it doesn't really matter. It won't affect the market regarding DXM and definitely won't affect it's regulation. The only thing that might happen is a bunch of lawsuits against avanir due to overdose of multiple drugs due to their enzyme inhibitating, medication potentiatior. Not to mention the bladders that will also be destroyed in the process of treatment.

 

[Venrak]

I actually said "wow - that's dangerous" out loud upon reading the ingredients.