Dextromethorphan and quinidine are suitable for off-label short-term treatment of agitation in people with Alzheimer's disease following first-line non-drug approaches

Commentary on : Cummings JL, Lyketsos CG, Peskind ER, et al. Effect of dextromethorphan-quinidine on agitation in patients with Alzheimer disease dementia: a randomized clinical trial. JAMA 2015;314:1242–54.[OpenUrl][1][CrossRef][2][PubMed][3] Agitation is a common and clinically important neuropsychiatric symptom in Alzheimer's disease (AD), conferring risk of distress, caregiver burden, mortality and institutionalisation. Non-drug approaches are best practice for first-line treatment.1 In cases warranting pharmacological treatment, options are limited. Atypical antipsychotics are only justified in cases of severe symptoms due to their lack of efficacy and extensive side effects.2 ,3 Innovation in this field is therefore a high priority. Treatment with dextromethorphan and quinidine has been proposed due to their mechanistic antagonism of nicotinic α3β4 receptor and low-affinity N -methyl-D-aspartate … [1]: {openurl}?query=rft.jtitle%253DJAMA%26rft.volume%253D314%26rft.spage%253D1242%26rft_id%253Dinfo%253Adoi%252F10.1001%252Fjama.2015.10214%26rft_id%253Dinfo%253Apmid%252F26393847%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [2]: /lookup/external-ref?access_num=10.1001/jama.2015.10214&link_type=DOI [3]: /lookup/external-ref?access_num=26393847&link_type=MED&atom=%2Febmed%2F21%2F1%2F25.atom