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Last Updated: April 24, 2025

CLINICAL TRIALS PROFILE FOR DEXTROMETHORPHAN HYDROBROMIDE; QUINIDINE SULFATE


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All Clinical Trials for dextromethorphan hydrobromide; quinidine sulfate

Trial IDTitleStatusSponsorPhaseStart DateSummary
NCT02153502 ↗ Efficacy, Safety, and Tolerability Study of AVP-786 as an Adjunctive Therapy in Patients With Major Depressive Disorder With an Inadequate Response to Antidepressant Treatment Completed Avanir Pharmaceuticals Phase 2 2014-07-01 The objectives of this 10-week study are to evaluate the efficacy, safety, and tolerability of AVP 786 as an adjunctive therapy compared with placebo in patients with major depressive disorder (MDD) who have shown an inadequate response to standard antidepressant treatment. A secondary objective of this study is to assess the pharmacokinetics (PK) of AVP-786 and potential correlations with pharmacodynamic effects.
NCT02174822 ↗ A Phase 1, Drug Interaction Study Between AVP-786 and Paroxetine and Between AVP-786 and Duloxetine in Healthy Subjects Completed Avanir Pharmaceuticals Phase 1 2014-01-01 To assess steady state pharmacokinetics (PK), safety and tolerability between AVP-786 (deuterated [d6] dextromethorphan hydrobromide [DM]/quinidine sulfate [Q]) and paroxetine and between AVP-786 and duloxetine.
NCT00573443 ↗ Safety and Efficacy of AVP-923 in PBA Patients With ALS or MS Completed INC Research Phase 3 2007-12-01 Objectives of the study are to evaluate the safety, tolerability, and efficacy of two different doses of AVP-923 (capsules containing either 30 mg of dextromethorphan hydrobromide and 10 mg of quinidine sulfate [AVP-923-30] or 20 mg of dextromethorphan hydrobromide and 10 mg of quinidine sulfate [AVP-923-20]) when compared to placebo, for the treatment of PBA in a population of patients with amyotrophic lateral sclerosis (ALS) or multiple sclerosis (MS) over a 12-week period. An additional objective is to determine the pharmacokinetic parameters of the two different doses of AVP-923 in a subset of the study population. Pseudobulbar Affect (PBA) is a condition characterized by involuntary, sudden and frequent episodes of laughing and/or crying out of proportion or incongruous to the underlying emotion of happiness or sadness Other terms used to describe this condition include emotional lability, emotionalism, emotional incontinence, emotional discontrol, excessive emotionalism, and pathological laughing and crying. The outbursts can occur spontaneously or in response to provocative stimuli such as questions or events. A body of evidence suggests that PBA can be modulated through pharmacologic intervention. Dextromethorphan (DM) is a low-affinity uncompetitive antagonist of the N-Methyl-D-aspartate (NMDA) receptor, reducing the level of excitatory activity. DM also acts at the phencyclidine-binding site, which is part of the NMDA receptor complex. DM is a sigma receptor agonist, suppressing the release of excitatory neurotransmitters. Quinidine (Q) is a known potent inhibitor of cytochrome P450 2D6 (CYP2D6), that decreases the metabolism of dextromethorphan and helps to achieve sustained and therapeutic levels of this drug.
NCT00573443 ↗ Safety and Efficacy of AVP-923 in PBA Patients With ALS or MS Completed Syneos Health Phase 3 2007-12-01 Objectives of the study are to evaluate the safety, tolerability, and efficacy of two different doses of AVP-923 (capsules containing either 30 mg of dextromethorphan hydrobromide and 10 mg of quinidine sulfate [AVP-923-30] or 20 mg of dextromethorphan hydrobromide and 10 mg of quinidine sulfate [AVP-923-20]) when compared to placebo, for the treatment of PBA in a population of patients with amyotrophic lateral sclerosis (ALS) or multiple sclerosis (MS) over a 12-week period. An additional objective is to determine the pharmacokinetic parameters of the two different doses of AVP-923 in a subset of the study population. Pseudobulbar Affect (PBA) is a condition characterized by involuntary, sudden and frequent episodes of laughing and/or crying out of proportion or incongruous to the underlying emotion of happiness or sadness Other terms used to describe this condition include emotional lability, emotionalism, emotional incontinence, emotional discontrol, excessive emotionalism, and pathological laughing and crying. The outbursts can occur spontaneously or in response to provocative stimuli such as questions or events. A body of evidence suggests that PBA can be modulated through pharmacologic intervention. Dextromethorphan (DM) is a low-affinity uncompetitive antagonist of the N-Methyl-D-aspartate (NMDA) receptor, reducing the level of excitatory activity. DM also acts at the phencyclidine-binding site, which is part of the NMDA receptor complex. DM is a sigma receptor agonist, suppressing the release of excitatory neurotransmitters. Quinidine (Q) is a known potent inhibitor of cytochrome P450 2D6 (CYP2D6), that decreases the metabolism of dextromethorphan and helps to achieve sustained and therapeutic levels of this drug.
NCT00573443 ↗ Safety and Efficacy of AVP-923 in PBA Patients With ALS or MS Completed Avanir Pharmaceuticals Phase 3 2007-12-01 Objectives of the study are to evaluate the safety, tolerability, and efficacy of two different doses of AVP-923 (capsules containing either 30 mg of dextromethorphan hydrobromide and 10 mg of quinidine sulfate [AVP-923-30] or 20 mg of dextromethorphan hydrobromide and 10 mg of quinidine sulfate [AVP-923-20]) when compared to placebo, for the treatment of PBA in a population of patients with amyotrophic lateral sclerosis (ALS) or multiple sclerosis (MS) over a 12-week period. An additional objective is to determine the pharmacokinetic parameters of the two different doses of AVP-923 in a subset of the study population. Pseudobulbar Affect (PBA) is a condition characterized by involuntary, sudden and frequent episodes of laughing and/or crying out of proportion or incongruous to the underlying emotion of happiness or sadness Other terms used to describe this condition include emotional lability, emotionalism, emotional incontinence, emotional discontrol, excessive emotionalism, and pathological laughing and crying. The outbursts can occur spontaneously or in response to provocative stimuli such as questions or events. A body of evidence suggests that PBA can be modulated through pharmacologic intervention. Dextromethorphan (DM) is a low-affinity uncompetitive antagonist of the N-Methyl-D-aspartate (NMDA) receptor, reducing the level of excitatory activity. DM also acts at the phencyclidine-binding site, which is part of the NMDA receptor complex. DM is a sigma receptor agonist, suppressing the release of excitatory neurotransmitters. Quinidine (Q) is a known potent inhibitor of cytochrome P450 2D6 (CYP2D6), that decreases the metabolism of dextromethorphan and helps to achieve sustained and therapeutic levels of this drug.
>Trial ID>Title>Status>Phase>Start Date>Summary
Showing 1 to 5 of 5 entries

Clinical Trial Conditions for dextromethorphan hydrobromide; quinidine sulfate

Condition Name

3111000.511.522.53Agitation in Patients With Dementia of the Alzheimer's TypePseudobulbar Affect (Involuntary Laughing and/or Crying)Pseudobulbar Affect (PBA)Schizophrenia[disabled in preview]
Condition Name for dextromethorphan hydrobromide; quinidine sulfate
Intervention Trials
Agitation in Patients With Dementia of the Alzheimer's Type 3
Pseudobulbar Affect (Involuntary Laughing and/or Crying) 1
Pseudobulbar Affect (PBA) 1
Schizophrenia 1
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Condition MeSH

3331000.511.522.53Alzheimer DiseasePsychomotor AgitationDementiaMotor Neuron Disease[disabled in preview]
Condition MeSH for dextromethorphan hydrobromide; quinidine sulfate
Intervention Trials
Alzheimer Disease 3
Psychomotor Agitation 3
Dementia 3
Motor Neuron Disease 1
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Clinical Trial Locations for dextromethorphan hydrobromide; quinidine sulfate

Trials by Country

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Trials by Country for dextromethorphan hydrobromide; quinidine sulfate
Location Trials
United States 138
Brazil 6
Argentina 4
Canada 3
Australia 2
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Trials by US State

+
Trials by US State for dextromethorphan hydrobromide; quinidine sulfate
Location Trials
Florida 7
Massachusetts 6
Illinois 6
Georgia 6
California 6
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Clinical Trial Progress for dextromethorphan hydrobromide; quinidine sulfate

Clinical Trial Phase

9.1%36.4%18.2%36.4%011.522.533.54Phase 4Phase 3Phase 2[disabled in preview]
Clinical Trial Phase for dextromethorphan hydrobromide; quinidine sulfate
Clinical Trial Phase Trials
Phase 4 1
Phase 3 4
Phase 2 2
[disabled in preview] 4
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Clinical Trial Status

81.8%9.1%9.1%00123456789CompletedRecruitingTerminated[disabled in preview]
Clinical Trial Status for dextromethorphan hydrobromide; quinidine sulfate
Clinical Trial Phase Trials
Completed 9
Recruiting 1
Terminated 1
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Clinical Trial Sponsors for dextromethorphan hydrobromide; quinidine sulfate

Sponsor Name

trials0123456789101112Avanir PharmaceuticalsINC ResearchSyneos Health[disabled in preview]
Sponsor Name for dextromethorphan hydrobromide; quinidine sulfate
Sponsor Trials
Avanir Pharmaceuticals 11
INC Research 1
Syneos Health 1
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Sponsor Type

84.6%15.4%0-10123456789101112IndustryOther[disabled in preview]
Sponsor Type for dextromethorphan hydrobromide; quinidine sulfate
Sponsor Trials
Industry 11
Other 2
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Dextromethorphan Hydrobromide and Quinidine Sulfate: Clinical Trials, Market Analysis, and Projections

Introduction

Dextromethorphan hydrobromide and quinidine sulfate, combined in the drug Nuedexta, have been a significant development in the treatment of pseudobulbar affect (PBA) and other neurological conditions. Here, we will delve into the clinical trials, market analysis, and future projections for this drug.

Clinical Trials Overview

Pseudobulbar Affect (PBA) Trials

The FDA approval of Nuedexta was based on a Phase III clinical trial known as the STAR trial. This double-blind, placebo-controlled study involved patients with underlying amyotrophic lateral sclerosis (ALS) or multiple sclerosis (MS). Patients were randomized to receive either Nuedexta (20mg/10mg or 30mg/10mg) or a placebo for 12 weeks. The primary outcome measure was the reduction in laughing and crying episodes, with secondary endpoints including the Center for Neurologic Studies Lability Scale (CNS-LS)[1][2][4].

Key Findings

  • The trial demonstrated a significant reduction in PBA episodes, with patients in the 20mg/10mg group experiencing an 82% mean weekly episode reduction from baseline, compared to a 47% reduction in the placebo group.
  • CNS-LS scores decreased by 8.2 points for both Nuedexta dosage groups, significantly more than the 5.7-point decrease in the placebo group.
  • A notable 51.4% of patients in the 20mg/10mg group achieved complete PBA remission, defined as no episodes during the final 14 days of the study[2][4].

Safety and Tolerability

The STAR trial also evaluated the safety and tolerability of Nuedexta. Common adverse events included dizziness, diarrhea, headache, nausea, somnolence, fatigue, nasopharyngitis, constipation, and dysphagia. Despite the use of quinidine, which can carry cardiac risks at higher doses, the low dose of 10mg in Nuedexta did not show increased reports of arrhythmias compared to the placebo group[2][4].

Additional Clinical Applications

Alzheimer's Disease-Related Agitation

A Phase 2 randomized, multicenter, double-blind, placebo-controlled trial assessed the efficacy, safety, and tolerability of dextromethorphan-quinidine for agitation in patients with Alzheimer's disease. The trial showed significant reductions in agitation scores, as measured by the Neuropsychiatric Inventory (NPI) Agitation/Aggression domain, without causing cognitive impairment, sedation, or clinically significant QTc prolongation[3].

Market Analysis

Approval and Launch

Nuedexta received FDA approval in October 2010 and was launched in the US in January 2011. It also gained marketing authorization from the European Commission in June 2013[1].

Market Impact

The drug has filled a significant gap in the treatment of PBA, a condition characterized by uncontrollable episodes of laughing or crying that are inappropriate to the situation. The market demand for effective treatments for PBA and other neurological conditions has driven the adoption of Nuedexta.

Economic Considerations

The economic impact of Nuedexta is substantial, given its effectiveness and the lack of alternative treatments. However, the absence of active comparator trials means it is unclear whether Nuedexta is superior to other agents, which could affect its market position and pricing[2][4].

Future Projections

Market Growth

Given the positive clinical trial outcomes and the unmet need for effective treatments in neurology, Nuedexta is expected to continue growing in the market. The drug's unique mechanism of action, combining dextromethorphan with low-dose quinidine to inhibit rapid metabolism and increase bioavailability, positions it favorably against potential competitors.

Potential New Indications

The success of dextromethorphan-quinidine in treating Alzheimer's disease-related agitation suggests potential for expansion into other neurological conditions. Further clinical trials could explore its efficacy in other areas, potentially broadening its market reach.

Regulatory and Competitive Landscape

As with any pharmaceutical, regulatory approvals and competitive dynamics will play a crucial role in Nuedexta's future. The drug's patent status and any upcoming generic versions could impact its market share. Additionally, new drugs entering the market could pose competition, although Nuedexta's established track record and clinical evidence will likely maintain its position.

Key Takeaways

  • Clinical Efficacy: Nuedexta has demonstrated significant efficacy in reducing PBA episodes and improving CNS-LS scores in clinical trials.
  • Safety Profile: The drug has a generally favorable safety profile, with common adverse events manageable and no significant cardiac risks at the low quinidine dose.
  • Market Position: Nuedexta fills a critical need in treating PBA and has potential for expansion into other neurological conditions.
  • Future Growth: Expected market growth driven by positive clinical outcomes and unmet medical needs.
  • Regulatory and Competitive Considerations: Ongoing regulatory approvals and competitive landscape will influence the drug's market position.

FAQs

What is Nuedexta used for?

Nuedexta is used for the treatment of pseudobulbar affect (PBA), a condition characterized by uncontrollable episodes of laughing or crying.

What are the active ingredients in Nuedexta?

The active ingredients in Nuedexta are dextromethorphan hydrobromide and quinidine sulfate.

What were the key findings of the STAR trial?

The STAR trial showed a significant reduction in PBA episodes and improvements in CNS-LS scores, with 51.4% of patients in the 20mg/10mg group achieving complete PBA remission.

Is Nuedexta safe for patients with Alzheimer's disease?

Clinical trials have shown that dextromethorphan-quinidine is generally well-tolerated in patients with Alzheimer's disease, reducing agitation without causing cognitive impairment or significant QTc prolongation.

What is the market outlook for Nuedexta?

Nuedexta is expected to continue growing in the market due to its efficacy and the unmet need for effective treatments in neurology.

Sources

  1. Clinical Trials Arena: Nuedexta for the Treatment of Pseudobulbar Affect (PBA)
  2. VA PBM: Dextromethorphan Hydrobromide and Quinidine Sulfate (Nuedexta) Drug Monograph
  3. PubMed: Effect of Dextromethorphan-Quinidine on Agitation in Patients With Alzheimer Disease
  4. VA PBM: Dextromethorphan Hydrobromide and Quinidine Sulfate (Nuedexta) Drug Monograph
  5. GlobalData: Net Present Value Model: (Deudextromethorphan hydrobromide + Quinidine sulfate)

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