P1‐340: The efficacy of dextromethorphan HBr and quinidine sulfate (Neudexta) treatment on agitation in patients with Alzheimer's disease: The caregivers' voice and clinical experience

Abstract

To investigate the effect of dextromethorphan HBr and Quinidine sulfate (Neudexta) in patients with Alzheimer's disease (AD) and agitation. All AD patients started on dextromethorphan HBr and quinidine sulfate treatment were assessed for any reported agitation. Those who exhibited agitation were evaluated prospectively. All met the DSM-IV and NINCDS-ADRDA criteria for possible Alzheimer's disease (AD). The status of behavioral improvement/deterioration was obtained from caregivers and family members. Medications used for the treatment of agitation were recorded initially and after four month of dextromethorphan HBr and quinidine sulfate therapy. Initial dosing of Neudexta was started at 20/10 mg in AM. Tolerability of medication was assessed after one week at a follow up visit. If no adverse effects, the dose was increased to twice a day. Patients were followed up monthly for four months. Twenty-seven patients were evaluated. Average MMSE was 14 (range 24-4). Initial concomitant medications for agitation were as follows: twenty-seven on neuroleptics, 12 (44%) on benzodiazepines and 6 (22%) were on other types of medications to control behaviors. All patients completed the study. There were no patients who stopped treatment due to adverse events. Caregivers reported that 9 (33%) had exhibited improved behavior during the 4 months of therapy. Twenty-two patients (81%) were still being treated with neuroleptics medications. The impact on benzodiazepines and other types of medications used for agitation was not assessed. Dextromethorphan HBr and quinidine sulfate treatment for patients with AD was associated with a 33% improvement rate in agitation as reported by caregivers. There was a 19% discontinuation rate of neuroleptic medications previously prescribed for agitation.