Editing Dexthromethorphan

[[Information on nutritional supplements people with ALS have been taking]]

[https://en.wikipedia.org/wiki/Dextromethorphan Wikipedia page]

[http://www.neurotransmitter.net/drugmechanisms.html neurotransmitter.net]:
:''Dextromethorphan (DXM) is commonly found in over the counter cough remedies.''

:''The drug's antitussive effects are mediated by sigma-1 and serotonin 5-HT1A receptors; at therapeutically relevant concentrations, DXM is likely to cause the activation of 5-HT1A receptors indirectly via the inhibition of serotonin reuptake.''

:''DXM exhibits relatively high affinity binding activity as a sigma-1 receptor agonist and serotonin reuptake inhibitor. DXM is also a noncompetitive NMDA receptor antagonist. The drug is four times more potent at NR1A/NR2A subunit-containing NMDA receptors than at NR1A/NR2B NMDA receptors. Furthermore, DXM exhibits a higher potency at NR1/NR2C receptors than at NR1/NR2A receptors. The active metabolite of DXM, dextrorphan, is a more potent noncompetitive NMDA antagonist and sigma-1 agonist than DXM. Dextrorphan and DXM also bind with low affinity to sigma-2 receptors. DXM and dextrorphan noncompetitively block alpha3beta4 neuronal nicotinic acetylcholine receptors; other nicotinic receptor subtypes may also be affected by these drugs.'' 


== Effects on ALS ==

Dextromethorphan (DM) is a dextrorotary morphinan and a widely used component of cough medicine.  Relatively high doses of DM in combination with quinidine are used for the treatment of mood disorders for patients with multiple sclerosis (MS). However, at lower doses, morphinans exert anti-inflammatory activities through the inhibition of NOX2-dependent superoxide production in activated microglia. {{#pmid:21704706|chechneva2011}}

Dextromethorphan is quickly metabolized and the resulting dextrorphan is unable to pass the blood brain barrier and enter the CNS. Adding the heart medicine quinidine 50 % of the weight of dextromethorphan will slow down the decay and significantly improve bioavailability. [source needed]

CONCLUSIONS:
These findings suggest that even patients with modest improvement while on DM/Q may experience quantifiable improvements in speech when assessed using sensitive and objective measures. This study provides additional evidence of the positive impact of DM/Q on one or more of the neural systems that control bulbar motor function and production of speech. {{#pmid:30152872|Green2018}}

== Cautions ==
May cause dizziness or drowsiness. Do not drive, use machinery, or do any activity that requires alertness until you are sure you can perform such activities safely. Avoid alcoholic beverages. MAO inhibitors may cause a serious (possibly fatal) drug interaction. Avoid taking isocarboxazid, methylene blue, moclobemide, phenelzine, procarbazine, rasagiline, selegiline, or tranylcypromine with dextromethorphan. MAO inhibitors should also not be taken for two weeks before. Other interactions are possible. ([http://www.webmd.com/drugs/2/drug-54288/dextromethorphan-cough-oral/ Source: WebMD])

== Discussion threads on the ALSTDI forum ==

[http://www.alstdi.org/forum/yaf_postst50622_how-much-dextromethorphan-is-too-much.aspx How much dextromethorphan is too much?]

[http://www.alstdi.org/forum/yaf_postst50482_cough-syrup-restores-speech-in-pals-overnight.aspx Cough syrup restores speech in PALS overnight]:
:''Do not use dextromethorphan if you have used an MAO inhibitor such as isocarboxazid (Marplan), phenelzine (Nardil), rasagiline (Azilect), selegiline (Eldepryl, Emsam), or tranylcypromine (Parnate) within the past 14 days. Serious, life-threatening side effects can occur if you take dextromethorphan before the MAO inhibitor has cleared from your body. ''

:''The dex dosage that is being used in the [Nuedexta] trial is 20mg 2X / day. (Plus 10mg quinidine 2X /. day - that is in a Nuedexta pill.) You can try the dex only. Others are varying the 20mg dosage but that is what they tend to start with. ''

[http://www.alstdi.org/forum/yaf_postst50343_nuedexta-trial-for-bulbar-issues-of-swallowing-and-speech.aspx Nuedexta trial for bulbar issues and speech?]

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== References ==


[[Category:Supplement data pages]]