REAL STORIES FROM REAL PATIENTS

Actor portrayal of PseudoBulbar Affect (PBA) patient treated with Nuedexta

Read patient profiles and watch videos of real people to get insight into how pseudobulbar affect (PBA) symptoms manifest, and how patient lives are affected.

Carol, a real patient living with PseudoBulbar Affect (PBA)
Carol, 54 years old

Carol is married and has two adult children. She works as a school librarian, so spends a lot of time interacting with the administration, teachers, and students.

Since Carol suffered from a traumatic brain injury (TBI) in the library, she has experienced uncontrollable crying episodes that leave her feeling frustrated and fearful about having another crying outburst in public.

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I never knew when it was going to come on. I was teaching and could feel a crying episode. One day, my principal said, ‘You’ve got to stop crying.’ It was horrible.
  • Primary neurologic condition: TBI (from accidental injury)
  • Impact of uncontrollable crying episodes: Worried about going out in public 
  • First diagnosis and treatment: Depression and antidepressants
  • Follow-up examination revealed: Crying episodes did not go away
  • Secondary diagnosis: Pseudobulbar affect (PBA)
Robert, a real patient living with PseudoBulbar Affect (PBA)
Robert, 64 years old

Robert was an army paratrooper who was wounded during a routine jump in 1991. He suffered multiple injuries, including a traumatic brain injury (TBI).

For 25 years after his accident, he experienced uncontrollable crying episodes that were confusing because he did not feel sad. He was diagnosed with depression and prescribed antidepressants but the crying spells continued.

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I always had that tough, military mindset. So, it was difficult not being able to manage my crying episodes in front of my buddies, family, even strangers. It has been really hard.
  • Primary neurologic condition: TBI (from accidental injury)
  • Impact of uncontrollable crying episodes: Avoided going out in public
  • First diagnosis and treatment: Depression and antidepressants
  • Follow-up examination revealed: Crying episodes did not go away
  • Secondary diagnosis: Pseudobulbar affect (PBA) 

Long-term Care Residents

Listen to Nurse Jennifer as she shares the stories of John and Sharon, two residents with PBA.

Real nurse discussing life of PseudoBulbar Affect (PBA) patients in a long-term care facility
Jennifer, BSN-RN, Registered Nurse Assessment Coordinator
Nurse Jennifer works closely with long-term care residents and explains what life is like for them when they suffer from PBA.
Read the real stories behind the people who nurse Jennifer talks about in her video.
John a real long-term care facility resident experiencing uncontrollable PseudoBulbar Affect (PBA) crying
John, 65 years old

Storyteller who loves activities with friends, suffered from a stroke that resulted in uncontrollable crying episodes.

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  • Primary neurologic condition: Stroke
  • Impact of uncontrollable crying episodes: Limited his interactions with other residents
  • First diagnosis and treatment: Depression, antidepressants, and antipsychotics
  • Follow-up examination revealed: Crying episodes did not go away
  • Secondary diagnosis: Pseudobulbar affect (PBA)
Sharon a real long-term care facility resident experiencing uncontrollable PseudoBulbar Affect (PBA) crying
Sharon, 78 years old

Known as the "town greeter," enjoys spending time chatting at the nurses' station and welcoming visitors to the nursing home where she lives.

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  • Primary neurologic condition: Stroke
  • Impact of uncontrollable crying episodes: Daughter visited less frequently, resident spent less time greeting visitors
  • First diagnosis and treatment: Depression suspected, but after evaluation was diagnosed with pseudobulbar affect (PBA)

INDICATION AND USAGE

NUEDEXTA® (dextromethorphan HBr and quinidine sulfate) is indicated for the treatment of pseudobulbar affect (PBA). PBA occurs secondary to a variety of otherwise unrelated neurologic conditions, and is characterized by involuntary, sudden, and frequent episodes of laughing and/or crying. PBA episodes typically occur out of proportion or incongruent to the underlying emotional state. PBA is a specific condition, distinct from other types of emotional lability that may occur in patients with neurologic disease or injury.

IMPORTANT SAFETY INFORMATION

CONTRAINDICATIONS

Quinidine and Related Drugs: NUEDEXTA contains quinidine, and should not be used concomitantly with other drugs containing quinidine, quinine, or mefloquine.

Hypersensitivity: NUEDEXTA is contraindicated in patients with a history of NUEDEXTA-, quinine-, mefloquine-, or quinidine-induced thrombocytopenia, hepatitis, bone-marrow depression, lupus-like syndrome, or known hypersensitivity to dextromethorphan (eg, rash, hives).

MAOIs: NUEDEXTA is contraindicated in patients taking monoamine oxidase inhibitors (MAOIs), or in patients who have taken MAOIs within the preceding 14 days, due to the risk of serious and possibly fatal drug interactions, including serotonin syndrome. Allow at least 14 days after stopping NUEDEXTA before starting an MAOI.

Cardiovascular: NUEDEXTA is contraindicated in patients with a prolonged QT interval, congenital long QT syndrome, history suggestive of torsades de pointes, heart failure, patients receiving drugs that both prolong QT interval and are metabolized by CYP2D6 (eg, thioridazine and pimozide), patients with complete atrioventricular (AV) block without implanted pacemaker, or at high risk of complete AV block.

WARNINGS AND PRECAUTIONS

Thrombocytopenia and Other Hypersensitivity Reactions: Quinidine can cause immune-mediated thrombocytopenia that can be severe or fatal. Non-specific symptoms, such as lightheadedness, chills, fever, nausea, and vomiting, can precede or occur with thrombocytopenia. NUEDEXTA should be discontinued immediately if thrombocytopenia occurs.

Hepatotoxicity: Hepatitis, including granulomatous hepatitis, has been reported in patients receiving quinidine, generally during the first few weeks of therapy. Discontinue immediately if this occurs.

Cardiac Effects: NUEDEXTA causes dose-dependent QTc prolongation. QT prolongation can cause torsades de pointes–type ventricular tachycardia, with the risk increasing as the degree of prolongation increases. When initiating NUEDEXTA in patients at risk for QT prolongation and torsades de pointes, electrocardiographic (ECG) evaluation of QT interval should be conducted at baseline and 3 to 4 hours after the first dose. Some risk factors include use with CYP3A4 inhibitors or drugs that prolong QT interval, electrolyte abnormalities, bradycardia, or left ventricular hypertrophy or dysfunction. If patients taking NUEDEXTA experience symptoms that could indicate the occurrence of cardiac arrhythmias (eg, syncope or palpitations), NUEDEXTA should be discontinued, and the patient further evaluated.

Concomitant Use of CYP2D6 Substrates: NUEDEXTA inhibits CYP2D6 and may interact with other drugs metabolized by CYP2D6. Adjust dose of CYP2D6 substrates as needed.

Dizziness: NUEDEXTA may cause dizziness. Take precautions to reduce the risk of falls.

Serotonin Syndrome: Use of NUEDEXTA with selective serotonin reuptake inhibitors (SSRIs) or tricyclic antidepressants increases the risk of “serotonin syndrome.”

Anticholinergic Effects of Quinidine: Monitor for worsening in myasthenia gravis.

ADVERSE REACTIONS

The most common adverse reactions (incidence of ≥3% and two-fold greater than placebo) in patients taking NUEDEXTA are diarrhea, dizziness, cough, vomiting, asthenia, peripheral edema, urinary tract infection, influenza, increased gamma-glutamyltransferase, and flatulence.

These are not all the risks for use of NUEDEXTA. Please see Full Prescribing Information.

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