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Using Dextromethorphan for Pseudobulbar Affect (PBA)

People who have PBA experience sudden episodes of crying or laughing that are out of their control, even when there does not seem to be anything to cry or laugh about. PBA is often associated with nervous system disorders that damage the area of the brain responsible for controlling the normal expression of emotion, such as:
 
 
Dextromethorphan is used in combination with quinidine (as Nuedexta) to treat PBA by decreasing the frequency of crying and laughing outbursts. Dextromethorphan treats the crying and laughing episodes, while quinidine decreases the rate at which the body breaks down dextromethorphan. This increases dextromethorphan levels in the blood.
 

How Does This Medication Work?

Dextromethorphan suppresses coughing through its actions in the "cough center" located in the brainstem, the lower part of the brain that connects to the spinal cord. It increases the threshold for coughing, which helps to reduce the body's reflex to cough.
 
Dextromethorphan has other actions in the brain as well. It blocks N-methyl-D-aspartate (NMDA) receptors, preventing the action of glutamate, an excitatory brain chemical. In addition, it binds to sigma receptors. Although the exact role of sigma receptors in the brain is unknown, they may play a role in certain neurological diseases. These actions may be responsible for dextromethorphan's effects in treating PBA.
 

Is It Safe for Children to Take Dextromethorphan?

Some, but not all, nonprescription dextromethorphan medicines can be used in children as young as four years old. Your pharmacist can help you choose a children's dextromethorphan product. Do not use this medicine in a child younger than four without approval from your child's healthcare provider.
 
Dextromethorphan should not be taken by children younger than two years old. Talk to your healthcare provider for more information about the risks and benefits of using dextromethorphan in children.
 
Written by/reviewed by:
Last reviewed by: Kristi Monson, PharmD;
Last updated/reviewed:
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