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当前位置:药品说明书与价格首页 >> 综合药讯 >> NUEDEXTA胶囊(氢溴酸右美沙芬20毫克/硫酸奎尼丁10毫克)

NUEDEXTA胶囊(氢溴酸右美沙芬20毫克/硫酸奎尼丁10毫克)

2011-02-26 09:24:24  作者:新特药房  来源:中国新特药网天津分站  浏览次数:1013  文字大小:【】【】【
简介: 近日,FDA已批准氢溴酸右美沙芬(20mg)+硫酸奎尼丁(10mg)胶囊(商品名Nuedexta)作为首个用于治疗假性延髓情绪(PBA)的药物。PBA又名情绪失禁,主要继发于脑损害或诸如多发性硬化、肌萎缩性脊髓侧 ...

 近日,FDA已批准氢溴酸右美沙芬(20mg)+硫酸奎尼丁(10mg)胶囊(商品名Nuedexta)作为首个用于治疗假性延髓情绪(PBA)的药物。PBA又名情绪失禁,主要继发于脑损害或诸如多发性硬化、肌萎缩性脊髓侧索硬化和中风之类的神经疾病,表现特征为突然出现无意识的或哭或笑。预期该药将于明年第1季度上市。

NUEDEXTA

NUEDEXTA完整的处方[附件]:/uploadfile/article/uploadfile/201102/20110226125552639.pdf]

Manufacturer:

Avanir Pharmaceuticals

Pharmacological Class:

Uncompetitive NMDA receptor antagonist and sigma-1 agonist + CYP2D6 inhibitor.

Active Ingredient(s):

Dextromethorphan HBr 20mg, quinidine sulfate 10mg; capsules.

Indication(s):

To treat pseudobulbar affect (PBA).

Pharmacology:

Dextromethorphan (DM) is a sigma-1 receptor agonist and an uncompetitive NMDA receptor antagonist. Quinidine increases plasma levels of DM by competitively inhibiting CYP2D6, which catalyzes a major biotransformation pathway for DM. The mechanism by which DM exerts its effects in PBA is unknown.

Clinical Trials:

The efficacy of Nuedexta was shown in one study in PBA patients with underlying amyotrophic lateral sclerosis or multiple sclerosis. Patients were randomized to receive Nuedexta, DM HBr 30mg/quinidine sulfate 10mg, or placebo. The primary outcome measure, laughing or crying episodes, was statistically significantly lower in each DM/quinidine arm compared to placebo. The secondary endpoint was the Center for Neurologic Studies Lability Scale (CNS-LS), a 7-item self-report questionnaire with 3 items assessing crying and 4 assessing laughter. The CNS-LS was analyzed based on the difference between the mean scores on day 84 and baseline, and was also statistically significantly lower in each DM/quinidine arm compared to placebo.

Two studies conducted using a higher dose combination (DM HBr 30mg/quinidine sulfate 30mg) provided evidence of Nuedexta efficacy.

Legal Classification:

Rx

Adults:

≥18 years: 1 capsule daily for 7 days, then (starting on Day 8) 1 capsule every 12 hours. Reevaluate periodically.

Children:

<18 years: not recommended.

Contraindication(s):

Concomitant quinidine, quinine, or mefloquine. History of quinine, mefloquine, or quinidine-induced thrombocytopenia, hepatitis, bone marrow depression, lupus-like syn­drome. Within 14 days of MAOIs. Prolonged QT interval. Congenital long QT syndrome. History of torsades de pointes. Heart failure. Drugs that prolong QT interval and are CYP2D6 substrates (eg, thioridazine, pimozide). Complete AV block w/o pacemaker, or risk of complete AV block.

Warnings/Precautions:

Discontinue if quinidine-related thrombocytopenia occurs (continued use may cause fatal hemorrhage); do not restart. Risk of QT prolongation and torsades de pointes (eg, concomitant drugs that prolong QT interval or that are strong or moderate CYP3A4 inhibitors, left ventricular hypertrophy, LVD): do ECG at baseline and 3–4 hours after 1st dose; reevaluate ECG if risk factors for arrhythmia (eg, electrolyte abnormality, bradycardia, family history of QT abnormality) change ­during treatment. Correct hypokalemia, hypomagnesemia before starting. Discontinue if arrhythmias occur. Myasthenia gravis. Consider genotyping for poor metabolizers of CYP2D6. Severe renal or hepatic impairment. Pregnancy (Cat. C). Nursing mothers.

Interaction(s):

See Contraindications. May cause serotonin syndrome with concomitant SSRIs (eg, fluoxetine) or TCAs (eg, clomipramine, imipra­mine). Accumulation of parent drug and/or failure of metabolite formation may decrease safety and/or efficacy of concomitant CYP2D6 substrates; adjust dose of CYP2D6 substrate or use alternative treatment. Concom­itant desipramine, paroxetine: reduce dose of these drugs, adjust based on response. Monitor digoxin; may need to reduce dose. Additive CNS effects with alcohol.

Adverse Reaction(s):

GI upset, dizziness, cough, asthenia, peripheral edema, UTI, flu, increased gamma-glutamyltransferase, flatulence; throm­bo­cytopenia, hypersensitivity, anticholinergic effects, hepatitis (discontinue if occurs).

How Supplied:

Caps—60

Avanir制药
药理分类:
缺乏竞争力的NMDA受体拮抗剂和Sigma - 1受体激动剂+ CYP2D6的抑制剂。
活性成分(补):
氢溴酸右美沙芬20毫克,10毫克的硫酸奎尼丁;胶囊。
指示(补):
治疗虚假效果(聚丙烯酸丁酯的)。
行动:
右美沙芬(DM)是一个Σ-
1受体激动剂和竞争力的NMDA受体拮抗剂。奎尼丁CYP2D6的抑制作用,以提升竞争力,催化转化的主要途径是糖尿病,糖尿病,血浆水平。马克这个机制发挥其在PBA的影响是未知的。

临床试验:
在Nuedexta影响的一项研究显示,在PBA的患者和肌萎缩性侧索硬化症,多发性硬化症的基础。患者随机接受Nuedexta,糖尿病,酸氢溴酸30mg/quinidine 10毫克或安慰剂。主要结果测量,笑或哭发作,每次显着/奎尼丁比安慰剂组低。次要终点为神经规模不稳定中心(中枢神经系统 - 镑),七自我评估报告,三笑哭和4评估问卷。中枢神经系统 - 之间,平均84天之间的差异分析,并根据基准LS和每个部门显着/奎尼丁比安慰剂组低。
与高剂量的两项研究(30毫克氢溴酸30mg/quinidine马克硫酸)的疗效Nuedexta结合,可提供证据。

法律分类:
接收
成人:
≥18岁:7天,每天如果(8天),每12小时一次。定期重新评估。
儿童:
<18年:不推荐。
禁忌(补):
奎尼丁,奎宁,或甲氟喹。对奎宁,甲氟喹或奎尼丁引起的血小板减少症,肝炎,骨髓抑制,狼疮样综合征的历史。单胺氧化酶抑制剂14天之内。
QT间期延长。先天性长QT综合征。德pointes的历史中的扭转性室速。心力衰竭。
QT间期延长的药物是一种CYP2D6的底物(如甲硫达嗪,匹莫齐特)。完全性房室传导阻滞W / O型的心脏起搏器,或完全性房室传导阻滞的危险。

警告/注意事项:
如果停止奎尼丁相关的血小板减少症发生(续使用可能会造成致命的出血),不重新启动。风险QT间期延长和扭转性室速德pointes的(例如,用药物延长QT间隔或强或中等的CYP3A4抑制剂,左心室肥厚,LVD)的:在基线心电图及第一剂后3-4小时心电图,如果重新评估心律失常的危险因素(如电解质紊乱,心动过缓,QT间期异常家族史)在治疗过程中的变化。权之前,低钾血症,低镁血症的开始。如果停止心律失常。重症肌无力。考虑CYP2D6基因新陈代谢缓慢。严重肾或肝损害。妊娠(目录三)。母乳喂养的母亲。

互动(补):
见禁忌。与SSRI类药物可能会导致药物(如氟西汀)或抗抑郁药物(如氯丙咪嗪,丙咪嗪),血清素综合症。母体药物和/或代谢产物可减少失败的安全性和/或性能与CYP2D6的底物的积累,CYP2D6的底物剂量调整或替代疗法的使用有关的形成。与地昔帕明,帕罗西汀:减少这些药物的剂量,调整的反应。监测地高辛;可能需要减少剂量。添加剂的中枢神经系统和酒精。

不良反应(补):
胃肠不适,头晕,咳嗽,疲劳,周边水肿,尿路感染,流行性感冒,增加γ-谷氨酰转移酶,胀气,血小板减少,过敏,抗胆碱作用,肝炎(阻止事件。)

如何提供:
第 - 60

责任编辑:admin


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