Dextromethorphan

Novel (glutamate NMDA antagonist, serotonin reuptake inhibition)

  • Bipolar Depression4
  • Treatment Resistant Depression2
  • Pseudobulbar affect (as Neudexta with quinidine)
  • Agitation in dementia (as Neudexta with quinidine)2
  • Misuse potential but not controlled

Features

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Dosing

Dextromethorphan 15-30 mg bid as monotherapy in bipolar depression, or augmented with bupropion 200-300 mg/day in unipolar

Can also use liquid OTC (dextromethorphan ER 30mg/5mL take 7.5ml bid) but prefer prescription tabs (less abuse potential).

Management

Works on own or as a quinidine-combination (Neudexta) for bipolar depression and TRD. Higher dose of dextramethorphan (30 mg bid) may also work. Quinidine prolongs the half-life of dextromethorphan, but should only be used in 10 mg dose (which is available in Neudexta or through compounding pharmacies).

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Diagnosis1

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