Key takeaways

Nuedexta is the only FDA-approved drug for pseudobulbar affect (PBA), but alternatives like tricyclic antidepressants, SSRIs, and dopaminergic agents exist for those who cannot tolerate it or find it too expensive.
The active ingredients of Nuedexta, dextromethorphan and quinidine, cannot be effectively substituted by taking them separately due to differences in formulation and effectiveness.
Off-label prescriptions of antidepressants and dopaminergic agents for PBA are common, with each alternative offering different side effects, costs, and dosages.
Switching from Nuedexta to an alternative treatment involves considerations like current health conditions, potential side effects, and drug interactions.

Nuedexta is a prescription drug used to treat pseudobulbar affect (PBA) in adults. PBA is a neurological condition that can cause uncontrollable laughing or crying episodes. Certain conditions, such as Alzheimer’s disease, multiple sclerosis, and Parkinson’s disease, are often linked to the development of PBA.

Nuedexta is a brand-name drug that contains a combination of dextromethorphan hydrobromide and quinidine sulfate. Dextromethorphan is commonly used as an antitussive or cough suppressant, while quinidine is classified as an antiarrhythmic drug. Although the exact way in which it works is unknown, Nuedexta is the only FDA-approved drug used to reduce PBA episodes.

Nuedexta is an effective drug for PBA but is only available as a brand-name drug. Without a generic version, Nuedexta can be expensive. Some people may also have trouble swallowing Nuedexta capsules or experience intolerable side effects from the drug. For these reasons, some healthcare providers and patients may be looking for a Nuedexta alternative.

Continue reading to learn more about Nuedexta alternatives.

What can I take in place of Nuedexta?

Some people might think they can take the active ingredients of Nuedexta separately. Delsym (dextromethorphan polistirex) is an available drug that contains dextromethorphan. However, Delsym contains dextromethorphan surrounded by an edible plastic called polistirex. The dextromethorphan in Delsym is quickly converted to dextrorphan, a metabolite of dextromethorphan that has antitussive effects and is not as effective for PBA as the dextromethorphan in Nuedexta. Quinidine is available as a separate oral tablet; however, quinidine tablets are only available in 200 mg or 300 mg strength, which is higher than the 10 mg strength of quinidine in Nuedexta.

There are no other FDA-approved drugs to treat PBA. However, some drugs may be prescribed for off-label use in which a healthcare provider can prescribe a drug for an unapproved condition.

Alternative Nuedexta treatment options include tricyclic antidepressants, such as Elavil (amitriptyline) and Pamelor (nortriptyline), and selective serotonin reuptake inhibitors (SSRIs), such as Celexa (citalopram), Zoloft (sertraline), and Prozac (fluoxetine). Antidepressants used to treat PBA are often prescribed at a lower dose than they normally would be prescribed for depression. They may have different costs, side effects, formulations, and dosages from Nuedexta.

Compare Nuedexta alternatives
Drug name	Uses	Dosage (for PBA)	Coupons
Nuedexta (dextromethorphan/quinidine)	Pseudobulbar affect (PBA)	20 mg/10 mg daily for 7 days, and then 20 mg/10 mg every 12 hours	Nuedexta coupons
Elavil (amitriptyline)	Depression Pseudobulbar affect (PBA) (off-label use)	10 to 75 mg daily Dosage may vary depending on the treated condition, the response to treatment, and other factors	Amitriptyline coupons
Pamelor (nortriptyline)	Depression Pseudobulbar affect (PBA) (off-label use)	10 to 25 mg daily Dosage may vary depending on the treated condition, the response to treatment, and other factors	Pamelor coupons
Celexa (citalopram)	Depression Pseudobulbar affect (PBA) (off-label use)	5 to 40 mg daily Dosage may vary depending on the treated condition, the response to treatment, and other factors	Celexa coupons
Zoloft (sertraline)	Depression Obsessive compulsive disorder (OCD) Panic disorder Post-traumatic stress disorder (PTSD) Social anxiety disorder (SAD) Premenstrual dysphoric disorder (PMDD) Pseudobulbar affect (PBA) (off-label use)	50 to 100 mg daily Dosage may vary depending on the treated condition, the response to treatment, and other factors	Zoloft coupons
Prozac (fluoxetine )	Depression Obsessive compulsive disorder (OCD) Bulimia nervosa Depressive episodes of bipolar disorder Pseudobulbar affect (PBA) (off-label use)	20 mg daily Dosage may vary depending on the treated condition, the response to treatment, and other factors	Prozac coupons
Lexapro (escitalopram)	Depression Generalized anxiety disorder (GAD) Pseudobulbar affect (PBA) (off-label use)	5 to 20 mg daily Dosage may vary depending on the treated condition, the response to treatment, and other factors	Lexapro coupons

Other alternatives to Nuedexta

Tofranil (imipramine)
Gocovri (amantadine)
Sinemet (carbidopa/levodopa)
Lamictal (lamotrigine)
Remeron (mirtazapine)
Edronax (reboxetine)
Effexor (venlafaxine)

Top 5 Nuedexta alternatives

The following are some of the most common alternatives to Nuedexta.

1. Tricyclic antidepressants (TCAs) such as Elavil (amitriptyline), Pamelor (nortriptyline), and Tofranil (imipramine)

Tricyclic antidepressants (TCAs) act on different neurotransmitters in the central nervous system (CNS). They mainly work by increasing serotonin and norepinephrine levels and blocking the action of acetylcholine. These drugs are approved to treat symptoms of depression. However, they may be prescribed off-label at lower doses for PBA. Some people may prefer to take a TCA due to the availability of low-cost, generic versions.

Although lower doses of TCAs may cause fewer side effects than high doses used for depression, side effects can still occur. Side effects of TCAs include dry mouth, constipation, blurred vision, and urinary retention.

2. Selective serotonin reuptake inhibitors (SSRIs) such as Celexa (citalopram), Prozac (fluoxetine), and Zoloft (sertraline)

Selective serotonin reuptake inhibitors (SSRIs) work by increasing levels of serotonin in the brain. They’re FDA approved to treat major depressive disorder, although some may also treat other mental health conditions, such as anxiety or OCD. A healthcare provider may prescribe an SSRI at low doses to reduce the frequency and severity of PBA episodes. SSRIs are widely available in brand and generic versions.

SSRIs generally have less severe side effects than older antidepressants, such as TCAs. Common side effects may include headache, dry mouth, insomnia, and sexual dysfunction.

3. Other antidepressants such as Remeron (mirtazapine) and Effexor (venlafaxine)

Other antidepressants may be prescribed off-label to treat PBA, including Remeron (mirtazapine) and Effexor (venlafaxine). Mirtazapine is an atypical antidepressant that helps balance norepinephrine and serotonin levels in the brain. Venlafaxine is a serotonin and norepinephrine reuptake inhibitor (SNRI) that also helps balance norepinephrine and serotonin levels. These antidepressants are approved to treat depression but may be used off-label for PBA. Drowsiness and other CNS side effects are possible with many antidepressants.

4. Dopaminergic agents such as Senemet (carbidopa/levodopa) and Gocovri (amantadine)

Dopaminergic agents have had lower response rates in people with PBA, but they may still be viable Nuedexta alternatives in some people. Glutamate is a neurotransmitter that binds to NMDA receptors and is believed to play a role in the development of emotional affect. Amantadine is an NMDA receptor antagonist that reduces the activity of glutamate. Carbidopa and levodopa influence dopamine activity in the brain. Small-scale clinical trials have shown that these dopaminergic agents may be effective in decreasing PBA episodes.

5. Lamictal (lamotrigine)

Lamictal is a brand-name drug also known by its generic name lamotrigine. It works as an anticonvulsant that reduces the actions of glutamate and aspartate, which are excitatory neurotransmitters. Lamictal is available as a generic drug. Side effects may include headaches, drowsiness, and dizziness.

Natural alternatives to Nuedexta

There are no approved natural remedies or supplements that can treat PBA. However, your healthcare provider may recommend coping strategies in addition to a prescription medication. A combination of medications and coping strategies may help make PBA easier to live with.

Relaxation methods

Relaxation methods, such as yoga, meditation, and deep breathing, may help alleviate a PBA episode. Yoga involves relaxing the body through a number of slow and controlled movements. Meditation can involve different practices, such as focusing on the breath or getting more in touch with the body. Practicing slow, deep breathing can also help calm the mind and body during an episode.

Distraction

Focusing on something else can help distract the mind during an episode. Working on a puzzle, journaling what’s happening in the environment, visualizing a specific memory, or counting backward from 100 can also help keep the mind busy enough to stop an episode in its tracks.

Moving away from the cause

Sometimes the best way to handle an episode is to remove yourself from the situation causing the episode. Take a break by going to a different room or walking outside. During severe episodes, removing yourself can be difficult. However, it’s still an option.

How to switch to a Nuedexta alternative

It can take time for Nuedexta to work. A healthcare provider may recommend waiting up to around 90 days for Nuedexta to start providing maximum benefits. Nuedexta may not work the same for everyone. If Nuedexta hasn’t reduced or improved PBA episodes or has caused unwanted side effects, it may be a good time to talk to a healthcare provider about switching medications.

Switching to a Nuedexta alternative

Switching to a Nuedexta alternative will depend on different factors, such as how long the current treatment with Nuedexta has been, side effects experienced from the drug, and the medication Nuedexta is being switched to. Nuedexta is not known to cause withdrawal symptoms that are common with other medications used for mental health conditions, such as antidepressants and antipsychotics. The only cases of withdrawal from dextromethorphan have been reported with the abuse or misuse of dextromethorphan syrup.

In many cases, Nuedexta can be discontinued immediately, and another drug can be started. However, the process for switching medications will be facilitated by the prescribing healthcare provider. To prevent adverse effects, a healthcare provider may recommend tapering or gradually lowering the dose of Nuedexta over time.

Switching between Nuedexta alternatives

Switching between Nuedexta alternatives can also involve different processes. Switching between different antidepressants may involve tapering the dose of the original drug or discontinuing the drug and directly switching to a different medication.

The treatment of pseudobulbar affect is possible through various medications. The best treatment option for you can vary based on the cost of the drug, current medical conditions, and potential side effects and drug interactions. Always discuss with a healthcare provider your current health condition and other drugs you’re taking, including prescription drugs, over-the-counter medicine, and herbal supplements, before taking a new medication.