Matching articles for "dextromethorphan"
Drugs for Depression
The Medical Letter on Drugs and Therapeutics • December 11, 2023; (Issue 1691)
A selective serotonin reuptake inhibitor (SSRI) is
generally used for initial treatment of major depressive
disorder (MDD). A serotonin-norepinephrine reuptake
inhibitor (SNRI), bupropion (Wellbutrin SR,...
A selective serotonin reuptake inhibitor (SSRI) is
generally used for initial treatment of major depressive
disorder (MDD). A serotonin-norepinephrine reuptake
inhibitor (SNRI), bupropion (Wellbutrin SR, and
others), and mirtazapine (Remeron, and others) are
reasonable alternatives. Improvement in symptoms
can occur within the first two weeks of treatment
with these drugs, but a substantial benefit may not be
achieved for 4-8 weeks.
Brexpiprazole (Rexulti) for Agitation in Alzheimer's Dementia
The Medical Letter on Drugs and Therapeutics • June 26, 2023; (Issue 1679)
The FDA has approved the oral second-generation
antipsychotic drug brexpiprazole (Rexulti – Otsuka/Lundbeck) for once-daily treatment of agitation associated
with dementia due to Alzheimer's disease...
The FDA has approved the oral second-generation
antipsychotic drug brexpiprazole (Rexulti – Otsuka/Lundbeck) for once-daily treatment of agitation associated
with dementia due to Alzheimer's disease (AD).
Brexpiprazole is the first drug to be approved in the US
for this indication. It is also approved for treatment of
schizophrenia and as an adjunct to antidepressants for
treatment of major depressive disorder.
Dextromethorphan/Bupropion (Auvelity) for Depression
The Medical Letter on Drugs and Therapeutics • December 26, 2022; (Issue 1666)
The FDA has approved an extended-release fixed-dose
combination of dextromethorphan and
bupropion (Auvelity – Axsome) for treatment of major
depressive disorder (MDD) in...
The FDA has approved an extended-release fixed-dose
combination of dextromethorphan and
bupropion (Auvelity – Axsome) for treatment of major
depressive disorder (MDD) in adults.
Drugs for Cognitive Loss and Dementia
The Medical Letter on Drugs and Therapeutics • August 22, 2022; (Issue 1657)
Alzheimer's disease (AD) is the most common
cause of dementia, but cognitive decline is also
associated with other neurological conditions such
as Parkinson's disease, dementia with Lewy bodies,
vascular...
Alzheimer's disease (AD) is the most common
cause of dementia, but cognitive decline is also
associated with other neurological conditions such
as Parkinson's disease, dementia with Lewy bodies,
vascular dementia, and frontotemporal dementia.
Drugs for Cough
The Medical Letter on Drugs and Therapeutics • December 17, 2018; (Issue 1562)
Acute cough (<3 weeks in duration) generally does
not require pharmacologic treatment, especially in
children. Suppression of productive cough may be
harmful. Management of patients with cough...
Acute cough (<3 weeks in duration) generally does
not require pharmacologic treatment, especially in
children. Suppression of productive cough may be
harmful. Management of patients with cough should
include elimination of any precipitating factor (e.g.,
cigarette smoking) and treatment of any underlying
cause such as upper airway cough syndrome,
gastroesophageal reflux disease, asthma, or other
pulmonary disease.
Drugs for Opioid Use Disorder
The Medical Letter on Drugs and Therapeutics • June 5, 2017; (Issue 1522)
Opioid use disorder is a chronic, relapsing disease with both physical and psychiatric components. It is
associated with economic hardship, social isolation,
incarceration, increased rates of...
Opioid use disorder is a chronic, relapsing disease with both physical and psychiatric components. It is
associated with economic hardship, social isolation,
incarceration, increased rates of blood-borne
infections such as HIV and viral hepatitis, adverse
pregnancy outcomes, and increased mortality.
According to the CDC, there were 33,091 deaths
related to opioid overdose in the US in 2015, more
than in any previous year. Several guidelines on the
management of opioid use disorder have recently
been published.
FDA Warns Against Use of Codeine and Tramadol in Children and Breastfeeding Women
The Medical Letter on Drugs and Therapeutics • May 22, 2017; (Issue 1521)
The FDA has issued new warnings about the use of the
opioid analgesics codeine and tramadol in children,
particularly those...
The FDA has issued new warnings about the use of the
opioid analgesics codeine and tramadol in children,
particularly those <12 years old, and in breastfeeding
women due to concerns about the risk of respiratory
depression and death. The FDA previously issued
warnings about these drugs in 2013 and 2015.
Drugs for Parkinson's Disease
The Medical Letter on Drugs and Therapeutics • November 1, 2013; (Issue 135)
The motor symptoms of Parkinson's disease (PD) are
caused primarily by progressive degeneration of
dopaminergic neurons in the substantia nigra. The non-motor
symptoms of the disease are thought to be...
The motor symptoms of Parkinson's disease (PD) are
caused primarily by progressive degeneration of
dopaminergic neurons in the substantia nigra. The non-motor
symptoms of the disease are thought to be caused
by degeneration of other neurotransmitter systems.
Dextromethorphan/Quinidine (Nuedexta) for Pseudobulbar Affect
The Medical Letter on Drugs and Therapeutics • June 13, 2011; (Issue 1366)
The FDA has approved Nuedexta (Avanir), a fixed-dose
combination of the cough suppressant dextromethorphan
hydrobromide and the antiarrhythmic
quinidine sulfate, for oral treatment of pseudobulbar
affect....
The FDA has approved Nuedexta (Avanir), a fixed-dose
combination of the cough suppressant dextromethorphan
hydrobromide and the antiarrhythmic
quinidine sulfate, for oral treatment of pseudobulbar
affect. The combination is the first treatment approved
by the FDA for this indication. Studies to support the
effectiveness of Nuedexta were performed in patients
with underlying amyotrophic lateral sclerosis (ALS) or
multiple sclerosis (MS); the drug has not been shown to
be safe or effective in other types of emotional lability.
In Brief: Benzonatate Warning
The Medical Letter on Drugs and Therapeutics • February 7, 2011; (Issue 1357)
The FDA recently warned that accidental ingestion of the antitussive benzonatate (Tessalon Perles, and others) by children less than 10 years old can be fatal.1 This widely prescribed oral agent, which has been...
The FDA recently warned that accidental ingestion of the antitussive benzonatate (Tessalon Perles, and others) by children less than 10 years old can be fatal.1 This widely prescribed oral agent, which has been available in the US since 1958, can also cause severe morbidity and death in older children and adults, and not only in overdosage.
Benzonatate is a polyglycol derivative structurally related to procaine and tetracaine. It acts peripherally on stretch receptors in the lower respiratory tract to suppress the cough reflex. If the patient chews or sucks the liquid-filled capsules or "softgels", the drug can cause laryngospasm, bronchospasm and circulatory collapse. Adverse effects that can occur after swallowing an intact capsule include a feeling of numbness in the chest, mental confusion, a sensation of burning in the eyes, and visual hallucinations.
Taken in overdose, benzonatate can rapidly cause seizures, cardiac arrhythmias and death. Serious adverse outcomes reported to the National Poison Center between 2000 and 2006 occurred in 116 patients (41 in children <6 years old), with 4 deaths.2 The 5 children known to the FDA who died from benzonatate ingestion were ≤2 years old and some apparently took only one or two capsules. In one well-documented case report, a 17-year-old girl who intentionally took 10 or more 200-mg capsules developed seizures, cardiac arrest from which she was resuscitated, and then blindness, which persisted.3 When a cough suppressant is truly necessary, dextromethorphan or even codeine might be a safer choice.
1. FDA. FDA Drug Safety Communication: Death resulting from overdose after accidental ingestion of Tessalon (benzonatate) by children under 10 years of age. Available at www.fda.gov/Drugs/DrugSafety/ucm236651.htm. Accessed January 27, 2011.
2. ML Winter et al. Benzonatate ingestion reported to the National Poison Center Database System (NPDS). J Med Toxicol 2010; 6:398.
3. V Cohen et al. Cardiac arrest with residual blindness after overdose of Tessalon (benzonatate) Perles. J Emerg Med 2009 Nov 4 (epub).
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Benzonatate is a polyglycol derivative structurally related to procaine and tetracaine. It acts peripherally on stretch receptors in the lower respiratory tract to suppress the cough reflex. If the patient chews or sucks the liquid-filled capsules or "softgels", the drug can cause laryngospasm, bronchospasm and circulatory collapse. Adverse effects that can occur after swallowing an intact capsule include a feeling of numbness in the chest, mental confusion, a sensation of burning in the eyes, and visual hallucinations.
Taken in overdose, benzonatate can rapidly cause seizures, cardiac arrhythmias and death. Serious adverse outcomes reported to the National Poison Center between 2000 and 2006 occurred in 116 patients (41 in children <6 years old), with 4 deaths.2 The 5 children known to the FDA who died from benzonatate ingestion were ≤2 years old and some apparently took only one or two capsules. In one well-documented case report, a 17-year-old girl who intentionally took 10 or more 200-mg capsules developed seizures, cardiac arrest from which she was resuscitated, and then blindness, which persisted.3 When a cough suppressant is truly necessary, dextromethorphan or even codeine might be a safer choice.
1. FDA. FDA Drug Safety Communication: Death resulting from overdose after accidental ingestion of Tessalon (benzonatate) by children under 10 years of age. Available at www.fda.gov/Drugs/DrugSafety/ucm236651.htm. Accessed January 27, 2011.
2. ML Winter et al. Benzonatate ingestion reported to the National Poison Center Database System (NPDS). J Med Toxicol 2010; 6:398.
3. V Cohen et al. Cardiac arrest with residual blindness after overdose of Tessalon (benzonatate) Perles. J Emerg Med 2009 Nov 4 (epub).
Download U.S. English
Drugs for Parkinson's Disease
The Medical Letter on Drugs and Therapeutics • January 1, 2011; (Issue 101)
Parkinson’s disease (PD) is caused primarily by progressive
degeneration of dopamine-containing neurons
in the substantia nigra. Dopamine itself cannot be
used to treat PD because it does not cross the...
Parkinson’s disease (PD) is caused primarily by progressive
degeneration of dopamine-containing neurons
in the substantia nigra. Dopamine itself cannot be
used to treat PD because it does not cross the blood-brain
barrier.
Drugs for Depression and Bipolar Disorder
The Medical Letter on Drugs and Therapeutics • May 1, 2010; (Issue 93)
Drugs are not the only treatment for mood disorders. Psychotherapy remains an important component in the management of these disorders, and electroconvulsive therapy (ECT) has a long history of efficacy and...
Drugs are not the only treatment for mood disorders. Psychotherapy remains an important component in the management of these disorders, and electroconvulsive therapy (ECT) has a long history of efficacy and safety
when drugs are ineffective, poorly tolerated or cannot be used. Some drugs are recommended here for indications that have not been approved by the FDA.
Drugs That May Cause Psychiatric Symptoms
The Medical Letter on Drugs and Therapeutics • December 15, 2008; (Issue 1301)
Many drugs can cause psychiatric symptoms, but a causal connection is often difficult to establish. Psychiatric symptoms that emerge during drug treatment could also be due to the underlying illness, previously...
Many drugs can cause psychiatric symptoms, but a causal connection is often difficult to establish. Psychiatric symptoms that emerge during drug treatment could also be due to the underlying illness, previously unrecognized psychopathology, or psychosocial factors. The withdrawal of some drugs can cause symptoms such as anxiety, psychosis, delirium, agitation or depression.
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Methylnaltrexone (Relistor) for Opioid-Induced Constipation
The Medical Letter on Drugs and Therapeutics • August 11, 2008; (Issue 1292)
The FDA has approved subcutaneous injection of methylnaltrexone (Relistor - Wyeth/Progenics), a selective mu-opioid receptor antagonist, for treatment of opioid-induced constipation in patients with advanced...
The FDA has approved subcutaneous injection of methylnaltrexone (Relistor - Wyeth/Progenics), a selective mu-opioid receptor antagonist, for treatment of opioid-induced constipation in patients with advanced illness (such as incurable cancer or end-stage chronic obstructive pulmonary disease) who are receiving palliative care.
AmpliChip CYP450 Test
The Medical Letter on Drugs and Therapeutics • August 15, 2005; (Issue 1215)
The FDA recently cleared the AmpliChip CYP450 Test (Roche), which analyzes blood-derived DNA to detect genetic variations in the activity of cytochrome P450 (CYP) enzymes CYP2D6 and CYP2C19 and determines the...
The FDA recently cleared the AmpliChip CYP450 Test (Roche), which analyzes blood-derived DNA to detect genetic variations in the activity of cytochrome P450 (CYP) enzymes CYP2D6 and CYP2C19 and determines the metabolizer status of the patient. The test is intended to help guide clinicians in prescribing individualized drug therapy. About 25% of all drugs, including many antidepressants and antipsychotics, are substrates of either CYP2D6 or CYP2C19. The test is being promoted initially to psychiatrists.
Drug Interactions with Grapefruit Juice
The Medical Letter on Drugs and Therapeutics • January 5, 2004; (Issue 1173)
The ability of grapefruit juice to increase serum concentrations of drugs was first discovered during a study of the effect of ethanol on felodipine (Plendil) pharmacokinetics. Double-strength grapefruit juice...
The ability of grapefruit juice to increase serum concentrations of drugs was first discovered during a study of the effect of ethanol on felodipine (Plendil) pharmacokinetics. Double-strength grapefruit juice used to disguise the taste of ethanol resulted in higher than expected serum concentrations of felodipine (DG Bailey et al, Clin Invest Med 1989; 12:357).
Drug Interactions
The Medical Letter on Drugs and Therapeutics • June 8, 2003; (Issue 1158)
Changes caused by one drug in the absorption, distribution, metabolism or excretion of another may lead to a pharmacokinetic adverse drug interaction (DN Juurlink et al, JAMA 2003; 289:1652). Additive drug...
Changes caused by one drug in the absorption, distribution, metabolism or excretion of another may lead to a pharmacokinetic adverse drug interaction (DN Juurlink et al, JAMA 2003; 289:1652). Additive drug interactions, such as vasodilation caused by both sildenafil (Viagra) and nitrates, can also have adverse effects.
Drugs That May Cause Psychiatric Symptoms
The Medical Letter on Drugs and Therapeutics • July 8, 2002; (Issue 1134)
Many drugs can cause psychiatric symptoms, but a causal connection is often difficult to establish. Psychiatric symptoms that emerge during drug treatment may also be due to the underlying illness, previously...
Many drugs can cause psychiatric symptoms, but a causal connection is often difficult to establish. Psychiatric symptoms that emerge during drug treatment may also be due to the underlying illness, previously unrecognized psychopathology, or psychosocial factors. The withdrawal of some drugs can cause symptoms such as anxiety, psychosis, delirium, agitation or depression.
Over-the-counter (OTC) Cough Remedies
The Medical Letter on Drugs and Therapeutics • March 19, 2001; (Issue 1100)
The number of cough remedies available in the USA continues to multiply, but most products contain the same or similar ingredients in varying combinations. Most acute coughs do not require treatment with drugs,...
The number of cough remedies available in the USA continues to multiply, but most products contain the same or similar ingredients in varying combinations. Most acute coughs do not require treatment with drugs, especially in children, and suppression of a productive cough may be harmful.
Drug Interactions
The Medical Letter on Drugs and Therapeutics • July 2, 1999; (Issue 1056)
Reports of adverse interactions between drugs continue to accumulate. Recently, the FDA has expanded the recommendations on drug interactions found in the package inserts of new...
Reports of adverse interactions between drugs continue to accumulate. Recently, the FDA has expanded the recommendations on drug interactions found in the package inserts of new drugs.
Sibutramine for Obesity
The Medical Letter on Drugs and Therapeutics • March 13, 1998; (Issue 1022)
Sibutramine hydrochlorid monohydreate (Meridia - Knoll), which is structurally related to amphetamine, has been approved by the FDA for treatment of obesity. It is classified by the Drug Enforcement Agency...
Sibutramine hydrochlorid monohydreate (Meridia - Knoll), which is structurally related to amphetamine, has been approved by the FDA for treatment of obesity. It is classified by the Drug Enforcement Agency (DEA) as a schedule IV controlled substance.