Editorial
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Psychiatr. Apr 19, 2020; 10(4): 29-33
Published online Apr 19, 2020. doi: 10.5498/wjp.v10.i4.29
Evidence for using dextromethorphan-quinidine for the treatment of agitation in dementia
Rajesh R Tampi, Pallavi Joshi, Padmapriya Marpuri, Deena J Tampi
Rajesh R Tampi, Department of Psychiatry and Behavioral Sciences, Cleveland Clinic Akron General, Akron, OH 44106, United States
Rajesh R Tampi, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH 44195, United States
Pallavi Joshi, Department of Psychiatry and Behavioral Sciences, Northwell Health-Staten Island University Hospital, Staten Island, NY 10306, United States
Padmapriya Marpuri, Department of Psychiatry, Einstein Medical Center, Philadelphia, PA 19141, United States
Deena J Tampi, Diamond Healthcare, Richmond, VA 23219, United States
Author contributions: All authors equally contributed to this manuscript.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Rajesh R Tampi, MD, Chairman, Department of Psychiatry and Behavioral Sciences, Cleveland Clinic Akron General, Akron, OH 44106, United States. rajesh.tampi@yale.edu
Received: February 8, 2020
Peer-review started: February 8, 2020
First decision: February 17, 2020
Revised: March 3, 2020
Accepted: March 22, 2020
Article in press: March 22, 2020
Published online: April 19, 2020
Processing time: 68 Days and 22 Hours
Abstract

Behavioral and psychological symptoms including agitation are common in dementia, and are associated with decreased quality of life, increased risk of institutionalization, and greater patient and caregiver distress. Pharmacological agents used for management of behavioral and psychological symptoms of dementia are limited by their tolerability, prompting a need for identifying efficacious and safe pharmacological treatments for managing agitation in dementia. The combination of dextromethorphan and quinidine sulfate is approved for pseudobulbar affect, and may be effective in managing agitation in dementia. A review of literature found only one randomized controlled trial that evaluated the use of dextromethorphan-quinidine for the management of agitation in dementia when compared to placebo. Data from this trial demonstrated that dextromethorphan-quinidine decreased agitation in dementia, and was well tolerated. Although promising, further research is needed before dextromethorphan-quinidine combination can be accepted as a standard treatment for agitation in dementia.

Keywords: Dextromethorphan; Quinidine; Agitation; Dementia; Behavioral and psychological symptoms of dementia

Core tip: Dextromethorphan-quinidine is approved for the treatment of pseudobulbar affect and may be effective in managing agitation in dementia. There is only one published trial that has evaluated the use dextromethorphan-quinidine for agitation in dementia. The study was of good quality and found that dextromethorphan-quinidine decreases severity of agitation when compared to placebo. Additionally, dextromethorphan-quinidine was fairly well tolerated and did not appear to cause significant sedation or worsen cognitive symptoms among individuals with dementia.