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Medicines > classes : Botanical or Dissociative or None

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generic:
brand:
None (43) · DXM (1) · DXO (1) · ketalar (1) · Laudanum, Dropizol (1) · Lithobid (1) · Nuedexta (1) · Spravato (1) · Ultracet, Tramacet (1)
classes: (Click arrow to add another value)
mechanism:
NMDA antagonist (3) · None (2) · Contains LSA (2) · Contains mescaline (2) · NMDA antagonist; sigma receptor agonist (2)
uses:
None (46) · Antimanic, Antidepressive, Antisuicide (1) · Pain, cough, disquiet (1) · Treatment-resistant depression (TRD) in adults, as adjunct to oral antidepressant (FDA-approved March 2019). Depressive symptoms in adults with MDD with acute suicidal ideation or behavior (FDA-approved Aug 2020). (1) · '"`UNIQ--vote-0000152F-QINU`"' (1) · '"`UNIQ--vote-00001582-QINU`"' (1)
starting dose:
None (48) · 1 capsule (20/10 mg dextromethorphan/quinidine) PO once daily × 7 days, then 1 capsule BID (1) · 2 tablets (75 mg tramadol / 650 mg acetaminophen) PO every 4-6 hours as needed; maximum 8 tablets/day for ≤5 days (1) · Induction (TRD): 56 mg intranasal twice weekly × 4 weeks. Maintenance: 56-84 mg once weekly × 4 weeks, then 56-84 mg every 1-2 weeks. For acute suicidality: 84 mg twice weekly × 4 weeks. Administered under medical supervision in REMS-certified site. (1)
preparations:
None (48) · 20 mg dextromethorphan HBr / 10 mg quinidine sulfate capsules (1) · 28 mg/device (each dose uses 2 devices) (1) · Tramadol/acetaminophen 37.5/325 mg tablets (1)
fda max:
None (48) · 1 capsule BID (40 mg DXM / 20 mg quinidine per day) (1) · 8 tablets/d (300 mg tramadol / 2600 mg acetaminophen); 5-day duration limit per label (1) · 84 mg per session (1)
routes:
None (48) · Intranasal (under direct medical supervision) (1) · Oral (2)
onset:
None (48) · 30-60 minutes (1) · PBA episode reduction within 1-2 weeks (1) · Within hours of first administration (1)
duration:
None (48) · 12 hours (1) · 4-6 hours (1) · Acute effect ~24 hours; cumulative effect builds with repeated dosing (1)
halflife:
None (48) · Dextromethorphan substantially prolonged by quinidine's CYP2D6 inhibition (typical extensive metabolizers see ~10× higher AUC); quinidine ~6-8 hours'"`UNIQ--ref-00001583-QINU`"' (1) · Tramadol ~5-7 hours (M1 metabolite ~9 hours); acetaminophen 1-3 hours'"`UNIQ--ref-00001530-QINU`"' (1) · ~7-12 hours (1)
bioavailability:
None (48) · Increased substantially via CYP2D6 inhibition'"`UNIQ--ref-00001584-QINU`"' (1) · Tramadol ~75% (oral); acetaminophen 85-98%'"`UNIQ--ref-00001531-QINU`"' (1) · ~48% intranasal (1)
pregnancy:
None (48) · Avoid; may cause fetal harm (1) · Avoid; neonatal opioid withdrawal documented.<sup class="pcp-cn" title="This claim needs a citation.">&#91;[[Pharmacopedia:Citation needed|citation&nbsp;needed]]&#93;</sup> (1) · Limited data; quinidine has been used in pregnancy as antiarrhythmic.<sup class="pcp-cn" title="This claim needs a citation.">&#91;[[Pharmacopedia:Citation needed|citation&nbsp;needed]]&#93;</sup> (1)
legal:
None (48) · Rx, Schedule III (US). REMS program required. (1) · [[USLegal:Prescription only|Rx-only]] in US. Caution with QT-prolonging medicines (quinidine itself is class IA antiarrhythmic, and the dose here, though sub-antiarrhythmic, still contributes to QT)'"`UNIQ--ref-00001585-QINU`"' (1) · [[USLegal:Schedule IV|Schedule IV controlled substance]] in US (tramadol was reclassified from non-controlled to Schedule IV in 2014 after recognition of dependence risk) (1)

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