Glentek/Riluzol (riluzole) vs Nuedexta (dextromethorphan HBr and quinidine sulfate)

When comparing Glentek/Riluzole (riluzole) with Nuedexta (dextromethorphan HBr and quinidine sulfate), it's important to note that they are used to treat different conditions: Riluzole is primarily used for the treatment of amyotrophic lateral sclerosis (ALS), slowing the progression of the disease, while Nuedexta is approved for the treatment of pseudobulbar affect (PBA), a condition characterized by sudden, uncontrollable episodes of crying and/or laughing. Riluzole works by decreasing the release of glutamate, which may help prevent nerve damage, whereas Nuedexta combines a cough suppressant with a medication that affects the rhythm of the heart to help regulate emotional expression. The choice between these medications would depend on the specific condition being treated; a patient with ALS may benefit from Riluzole, while one with PBA would likely be prescribed Nuedexta.

Difference between Glentek/Riluzol and Nuedexta

Metric	Glentek/Riluzol (riluzole)	Nuedexta (dextromethorphan HBr and quinidine sulfate)
Generic name	Riluzole	Dextromethorphan hydrobromide and quinidine sulfate
Indications	Treatment of amyotrophic lateral sclerosis (ALS)	Treatment of pseudobulbar affect (PBA)
Mechanism of action	Reduces glutamate release, which may slow down neuronal degeneration	Dextromethorphan acts on the central nervous system to reduce the excitability of the neurons responsible for the PBA symptoms; quinidine increases the plasma level of dextromethorphan by inhibiting its metabolism
Brand names	Glentek, Rilutek, Tiglutik	Nuedexta
Administrative route	Oral	Oral
Side effects	Dizziness, gastrointestinal disturbances, liver function alterations	Dizziness, diarrhea, cough, vomiting, weakness, swelling of extremities, urinary tract infections, flu-like symptoms
Contraindications	Liver impairment, caution in patients with a history of drug-induced liver injury	Hypersensitivity to dextromethorphan or quinidine, history of heart failure or arrhythmias, concomitant use with MAO inhibitors or within 14 days of stopping MAO inhibitors
Drug class	Glutamate antagonist	Central nervous system agent
Manufacturer	Sanofi, ITF Pharma, various generic manufacturers	Avanir Pharmaceuticals

Efficacy

Efficacy of Riluzole (Rilutek/Glentek) in ALS

Riluzole, marketed under brand names such as Rilutek and Glentek, is a medication specifically approved for the treatment of Amyotrophic Lateral Sclerosis (ALS). The efficacy of riluzole in ALS has been demonstrated in multiple clinical trials. It is believed to work by reducing the release of glutamate, which is thought to be involved in the death of neurons that is characteristic of ALS. Studies have shown that riluzole can prolong survival by several months, particularly in the bulbar form of the disease, which affects speech and swallowing. Additionally, riluzole may delay the time to tracheostomy or the use of ventilatory assistance, which are common in the later stages of ALS.

Despite its benefits, riluzole does not halt the progression of ALS or reverse the damage already done to motor neurons. Its efficacy is generally considered modest, but it remains one of the few treatments that have a proven impact on survival. The medication is typically well-tolerated, although some patients may experience side effects such as asthenia, nausea, and elevated liver enzymes, which require monitoring.

Efficacy of Nuedexta in ALS

Nuedexta, a combination of dextromethorphan HBr and quinidine sulfate, is not primarily indicated for the treatment of ALS. However, it has been studied for its efficacy in managing a symptom associated with ALS known as pseudobulbar affect (PBA). PBA is characterized by uncontrollable episodes of laughing or crying that are disproportionate or unrelated to the patient's emotional state. In clinical trials, Nuedexta has shown efficacy in reducing the frequency and severity of PBA episodes in patients with ALS.

While Nuedexta's direct impact on the progression of ALS is not established, the improvement in PBA symptoms can significantly enhance the quality of life for patients suffering from this condition. It is important to note that the use of Nuedexta for the treatment of PBA in ALS patients is an off-label use, and the combination of dextromethorphan and quinidine works by affecting the signaling in the brain that may become dysregulated in conditions like ALS. As with any medication, the potential benefits of Nuedexta should be weighed against possible side effects, which can include dizziness, nausea, and an increased risk of cardiac arrhythmia due to the quinidine component.

Regulatory Agency Approvals

Glentek/Riluzol

European Medical Agency (EMA), European Union
Therapeutic Goods Administration (TGA), Australia
Medicines & Healthcare products Regulatory Agency (MHRA), United Kingdom
The Medicines Evaluation Board (MEB), The Netherlands

Nuedexta

Food and Drug Administration (FDA), USA

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